CN117280269A - Peripheral anti-defocus optical apparatus - Google Patents

Abstract

A contact or spectacle lens for correcting defocus in a peripheral eye, the lens having a central region for correcting ametropia in a central portion and an aspherical annular anti-defocus region adjacent to and extending radially outwardly from the central region. The asphericity of the vertical meridian of the anti-defocus region is lower than the asphericity of the horizontal meridian of the anti-defocus region, and the horizontal and vertical meridians are blended with progressively varying e-values to form a smooth optical surface.

Description

Peripheral anti-defocus optical apparatus

Background

Many people experience difficulties in their vision due to many possible circumstances. One of the most common vision problems is a condition known as myopia or nearsightedness. Myopia is a common condition in which the eye cannot focus on distant objects because the cornea of the eye is either curved too steeply (i.e., the radius of curvature of the cornea is less than normal) or the axial length is too long to provide adequate focus on the retina of the eye. Another condition is known as hyperopia or presbyopia. For hyperopia, the eye cannot focus on distant objects and near objects because the curvature of the cornea of the eye is too flat (i.e., the radius of curvature of the cornea is greater than normal) or the axial length is too short to provide adequate focus on the retina of the eye. Another form of vision problem is astigmatism, in which the unequal curvature of one or more refractive surfaces of the cornea prevents light from being sharply focused at a point on the retina, resulting in blurred vision. Presbyopia is the most common vision problem in adults 40 years and older due to aging and hardening of the lens. Presbyopia symptoms can occur in young adults or children, without hardening of the lens as part of the problem of visual efficiency, and are referred to as lack or deficiency of accommodation flexibility.

In addition to the problem of visual acuity, normal human vision requires effective eye coordination (eye mapping) and visual efficiency skills for near-far tasks. The visual efficiency skills of the human eye include three parts, namely, adjustment of focus, convergence of binocular alignment, and eye movement control for fixation and tracking of codes or objects. Complete visual acuity and visual efficiency skills are necessary for efficient information processing in the brain of messages received by the human eye. There are also subdivision skills among each of the three visual efficiency skills. A trained ophthalmologist or ECP (eye care practitioner) can perform a comprehensive visual efficiency check to discover and manage any defects. One of the well known conventional checks for visual efficiency is the OEP-21 point functional test. OEP is an abbreviation underlying the extensional program of the optometer located in california, usa. Can pass through NSUCO, SCCO, DEM ^TM And ReadAlyzer/Visagraph tests, etc., to analyze the evaluation of eye movement control. There is increasing evidence showing a relationship between visual efficiency and learning difficulties, such as ADHD/ADD (with/without hyperactivity, attention deficit disorder) and dyslexia.

Methods of correcting vision or visual acuity may include wearing eyeglasses, wearing contact lenses, lasik surgery, and orthokeratology. Conventional methods of improving visual efficiency are typically through VT (visual training), which is an operative conditioned reflex training used to teach patients how to control their eyes for eye coordination. The VT process may be supplemented with spherical lenses to relieve focus/accommodation stress or prismatic lenses to supplement the vergence requirements due to excessive deviation angles. VT typically requires office and home training for several months or even one year in succession to increase the degree of automation of operative conditioned reflex skills, which may deteriorate and require frequent reinforcement to maintain proper functioning of the skills. In difficult cases, supplemental spherical or prismatic devices may help with the initial VT, while eye coordination may accommodate the new focusing or vergence requirements of the supplemental optical devices provided, and worsen again with transient relief of symptoms. Some visual efficiency problems, such as insufficient Convergence (CI), excessive Convergence (CE), and insufficient Accommodation (AI), can cause eyestrain and accelerate myopia progression. Improving visual efficiency can significantly slow or stop myopia progression.

Despite the foregoing, there remains a need for devices or processes that better improve visual efficiency.

Disclosure of Invention

In one embodiment, the present invention provides improved visual efficiency through the use of anti-defocus lenses, such as spectacle lenses or contact lenses, for correcting peripheral eye defocus. The lens has a central zone 20 at a central portion of the lens, the central zone having a lens power for correcting ametropia, and an aspherical annular anti-defocus (ADF) zone 21 adjacent the central zone 20 and extending radially outwardly from the central zone 20. The front or back surface of the lens has a horizontal meridian and a vertical meridian, each meridian having an e-value, and in the ADF region, the asphericity of the vertical meridian of the ADF region is less than the asphericity of the horizontal meridian of the ADF region. The vertical meridian of the ADF region 21 may have, for example, a zero e-value, and/or the e-value of the vertical meridian may be less than 1/2 of the e-value of the horizontal meridian. The curvature of the lens surface between the horizontal meridian and the vertical meridian blends with progressively varying e-values to form a smooth optical surface. In one embodiment, the vertical meridian of ADF region 21 may be a single vision curve having the same power as central region 20.

When the lens is an ophthalmic lens, the horizontal and vertical meridians may be on the front or back of the lens, preferably on the back. The central region preferably has a diameter of 1.5mm to 4.0mm, and the central region and ADF region together preferably have a diameter of 18mm to 28 mm. Such a spectacle lens may have an ADF zone with a horizontal meridian that is aspherical and has a positive progressive power radially outward from the inner boundary of the ADF zone, and may have an anti-defocus power (ADP) of +1.00 to +20.0 diopters, which is defined as the power difference between the outer periphery of the ADF zone 21 and the outer periphery of the central zone 20. Such lenses are useful in the treatment of presbyopic defocus. Ophthalmic lenses useful in the treatment of myopic defocus may be provided with an ADF region 21 having a horizontal meridian that is aspherical and has a progressive negative power radially outward from the inner boundary of the ADF region, and the horizontal meridian has an anti-defocus power (ADP) of-1.00 to-20.0 diopters.

When the lens is a contact lens, the diameter of the central region is preferably 0.5mm to 1.0mm, the ADF region 21 preferably extends radially outwardly from the central region at least 3mm to 4mm, and the diameter of the central region 20 and the annular ADF region 21 together is preferably 6mm to 10mm. The lens may be, for example, a rigid corneal lens, a rigid scleral lens, or a soft contact lens. Such contact lenses may further include an intermediate zone 24, the intermediate zone 24 being coupled to the ADF zone 21 and extending radially outwardly from the ADF zone 21, preferably having a zone width of 2.0mm to 5.0 mm; a connection region 26 coupled to and extending radially outwardly from the intermediate region 24 for carrying the contact lens on the cornea; and a peripheral region 28 coupled to the periphery of the contact lens. In embodiments of contact lenses used in performing orthokeratology, the horizontal and vertical meridians are on the back of the lens in order to achieve corneal molding.

The e-values of the front or back sides of the center region 20 and ADF region 21 of the contact lens embodiment may be combined to form an aspheric center-ADF region 20-21, and the horizontal and vertical meridians of such center-ADF region 20-21 may be rotated with respect to each otherThe progressive e-values combine to form a center-ADF region with a continuously smooth aspheric surface. In this embodiment, the vertical meridian may have an e-value of zero and may have single vision power throughout the center-ADF region 20-21. The e value of the horizontal meridian in this embodiment is preferably non-zero and may be between + -0.1e and + -3.0 e. Axis X along center-ADF region ^o Is a rotational progressive e value of (2) _x ECan be derived by the following formula:

E _x ＝SIGN(XR _p -R _c )*(ABS(XR _p ² -R _c ² )) ^1/2 /d (equation 2.2),

wherein XR _p Is along axis X ^o Radius of curvature at a point radially outward a distance d, and XR _p Derived from the following formula:

XR _p ＝HR _p +sin(X ^o ) ² *(VR _p -HR _p ) (equation 2.1),

wherein R is _c Is the radius of curvature at the center of the contact lens, and HR _p Is the radius of curvature at a point radially outward along the horizontal meridian by a distance d, where VR _p Is the radius of curvature at a point radially outward along the vertical meridian by a distance of "1 d".

In contact lens embodiments used in the treatment of presbyopic defocus, the horizontal meridian has a positive power progressing radially outward from the central portion of the lens and has an anti-defocus power (ADP) of +1.00 to +30.0 diopters. The front face of the horizontal meridian of such a lens preferably has an e-value between-0.1 e and-3.0 e, or the back face of the horizontal meridian preferably has an e-value between +0.1e and +3.0 e.

In contact lens embodiments used in the treatment of myopic defocus, the horizontal meridian has a progressive negative power radially outward from the central portion of the lens and has an anti-defocus power (ADP) of-1.00 to-30.0 diopters. The front face of the horizontal meridian of such a lens preferably has an e-value between +0.1e and +3.0e, or the back face of the horizontal meridian preferably has an e-value between-0.1 e and-3.0e.

The present invention also provides a method for improving or correcting the visual efficiency problem of the above-described lenses by correcting peripheral eye defocus in the subject's eye. The visual efficiency problem may be, for example, eye movement dysfunction, accommodation dysfunction, vergence dysfunction, or abnormal sensory accommodation. The method may include determining an anti-defocus power (ADP) of a lens having a central region 20 in a central portion thereof and an anti-defocus region 21 adjacent to the central region 20 and extending radially outwardly from the central region 20. The central region has a central focus to form a central image in the fovea for correction of ametropia, and the determined ADP is sufficient to counteract peripheral eye defocus and realign the peripheral image in the subject's eye in order to improve peripheral fusion and visual efficiency. Determining an anti-defocus power (ADP) in the method may further comprise examining baseline visual efficiency data of the subject; selecting an ADF test lens based on the type of visual efficiency problem experienced by the subject; and testing the original eye defocus intensity by progressively introducing the selected ADF test lenses from a lower ADP to a higher ADP until a determination is made of the best ADP to achieve maximum normalization of visual efficiency data. The subject may then be provided with a pair of spectacles or contact lenses with optimal ADP. The step for determining the optimal ADP may be repeated after the subject has worn the provided spectacles or contact lenses for a predetermined period of time. To correct binocular efficiency problems or to control myopia with presbyopic defocus, the horizontal meridian of the ADF region 21 is aspherical and has a progressive positive power radially outward from the inner boundary of the ADF region, preferably with an ADP of +1.00 to +20.0 diopters. For treatment of myopic defocus, the horizontal meridian of the ADF region 21 is aspherical and has a progressive negative power radially outward from the inner boundary of the ADF region, preferably with an ADP of-1.00 to-20.0 diopters. In one embodiment, a significant anti-defocus effect is induced in the subject's eye, with peripheral focal spots at least 0.50 diopters relative to anterior (more myopic) or posterior (more distant) vision, measured at 10 degrees on each side of the subject's fovea (N10 and T10). In another embodiment, a significant anti-defocus effect is induced in the subject's eye with peripheral focal spots at least 2.00 diopters relative to anterior (more myopic) or posterior (more distant) as measured at 20 degrees on each side of the subject's fovea (N2O and T2O).

Drawings

Fig. 1 is a schematic illustration of forming an on-axis image on an eye.

Fig. 2 is a schematic illustration of forming an alignment axis image on an eye.

Fig. 3 is a cross-sectional view of an anti-defocus (ADF) contact lens embodiment of the apparatus of the present invention taken along line 3-3 of fig. 4.

Fig. 4 is a plan view of the upper side (front) of the contact lens of fig. 3.

Fig. 5 is a plan view of the underside (back side) of the contact lens of fig. 3.

Fig. 6 is a cross-sectional view of a myopic defocus-resistant (M-ADF) orthokeratology contact lens embodiment of the present device taken along line 6-6 of fig. 7.

Fig. 7 is a plan view of the contact lens of fig. 6.

Fig. 8 is a cross-sectional view of a hyperopic defocus-resistant (H-ADF) orthokeratology contact lens embodiment of the present invention taken along line 8-8 of fig. 9.

Fig. 9 is a plan view of the contact lens of fig. 8.

Fig. 10 is a front view of an eyeglass lens embodiment of the present device.

Fig. 11 is a diagram of a bernoulli fusion region.

Reference numerals in the drawings denote the following features:

Detailed Description

Definition of the definition

As used herein, the following terms and variations thereof have the meanings given below, unless the context in which such terms are used clearly means a different meaning.

"AC/A ratio" refers to the ratio of accommodation convergence AC (in prism diopters) to stimulus accommodation A (in diopters). The most common method of determining this ratio is according to the gradient method (or gradient test), where near strabismus is measured with spherical lenses (typically +1.00D or-1.00D) placed in front of both eyes after changing accommodation. Expressed as: AC/a= (α - α ')/F, where α is near presbyopia and α' is presbyopia at the same distance but through a lens of power F. The deviation is measured in prism diopters, where + represents the internal strabismus and-represents the external strabismus.

An "accommodation dysfunction" is a problem in an accommodation system in that the eye changes optical power as its distance changes, either maintaining a clear image or focusing on an object. There are several types of regulatory dysfunctions, involving one or more of the following diagnoses: (1) under-regulation; (2) insufficient flexibility of adjustment; and (3) overregulation.

The "ADD power" is the difference in power between the far and near powers of the lens. For spectacles, ADD is measured on a plane 12mm in front of the anterior corneal surface. ADD is increased or decreased, respectively, for distances having the apex correction formula fc=f/(1-xF), where Fc is the power corrected for apex distance, F is the original lens power, and x is the change in apex distance in meters, for any other device having a trajectory that is closer to or farther from the anterior corneal surface.

"Anti-defocus" means an optical device, such as a pair of eyeglasses, soft contact lens, rigid contact lens, cornea shaping lens, or intraocular lens, having a central optical zone 20 for correcting refractive errors of the eye and forming a central focus in the fovea of the retina, and a peripheral Anti-defocus zone 21 adjacent to the central optical zone 20 and outward from the central optical zone 20 for directing either a posterior (longer) or anterior (shorter) peripheral focus to correct peripheral eye defocus. A myopic anti-defocus (M-ADF) device is provided to extract the backward (longer) peripheral focus to counteract myopic eye defocus and a hyperopic anti-defocus (H-ADF) device is provided to extract the forward (shorter) peripheral focus to counteract hyperopic eye defocus.

The "defocus-resistance" (ADP) of an ADF device is the difference in power between (a) the outermost portion (periphery) 21c of the ADF region 21 and (B) the outermost portion (periphery) 20c of the center region 20 (corresponding to the inner boundary 22 of the ADF region 21), i.e., adp=a-B. ADP is positive power for an H-ADF device and negative power for an M-ADF device.

The "ADP effect" is a substantial anti-defocus effect when the ADF device is worn on the human eye, which can be measured with a bright field refractometer (open field refractometer) or a Shack-Hartmann system to compare the peripheral refraction with the ADF device to the baseline peripheral refraction without the ADF device. ADP effect = a-B at a certain offset angle relative to the fovea. The deviation angle for measuring ADP is generally set to be 10 °, 20 °, 25 °, 30 ° (degrees) horizontally with respect to each side (nasal side and temporal side) of the foveal retina.

"associative strabismus (associated phoria)" is defined as the amount of prism required to reduce the solid parallax (fixation disparity) to zero.

The "back" of the lens refers to the surface from which light exits the lens for its normal and intended use. For example, for a contact lens, the back surface is the surface that contacts the subject's eye when worn by the subject.

"base curve" refers to the curvature of the back surface of the contact lens.

"binocular fusion" is the visual perception of a single binocular image that allows two eyes to perceive the surrounding of a person. Binocular fusion occurs only in a small portion of the visual space where the eye is looking. Passing through the fixation point in the horizontal plane is a curve known as the experience level binocular single vision (horopter) 62. There is also an empirical vertical binocular single vision that is tilted from the eye above the fixation point and oriented towards the eye below the fixation point. The horizontal and vertical binocular single vision field 60 marks the center of the single vision volume. Within this thin, curved volume, objects that are closer and farther than the single vision of both eyes are considered to be a single object. This volume is referred to as the bernoulli fusion zone 64 (see fig. 11). Outside the area of the pnum fusion, a double vision occurs.

"convergence" is a phenomenon in which the eyes rotate inward to focus on a subject, and the degree of eye rotation indicates to the brain how close or far the subject is, the closer subject requiring a greater degree of inward rotation than the subject farther from the face. For convergence, near triplet motion (near triad) occurs, eye convergence, accommodation is activated and pupil constriction.

A "contact lens" is a lens that is placed on the outer surface of a subject's eye.

The "curvature" or "radius of curvature" of a lens is typically measured in millimeters (mm) and expressed in diopters or mm. When expressed in diopters, the curvature is determined by the appropriate refractive index. For example, for contact lenses, when expressed in diopters, the refractive indices of air and tear are considered along with the refractive index of the lens material in determining the curvature, whereas for spectacles only the refractive indices of air and lens material need to be used. For other lenses (e.g., thicker lenses or intraocular lenses), the curvature may be determined by the topographer device or radius range using appropriate index information, using appropriate formulations and refractive indices known to those skilled in the art.

"defocus" refers to the translation of a focal point along the optical axis away from a detection surface (e.g., retinal surface). Typically, defocus reduces the sharpness and contrast of an image. The high contrast edges in the scene that should be sharp become gradual and the fine details in the scene are blurred or even become invisible.

“DEM ^TM The test "is a developmental eye movement test that incorporates subtesting of digital calls in a vertical array and provides a means to evaluate eye movement function with numbers in a horizontal array. DEM (digital elevation model) ^TM The tests were developed by dr. Jack Richman OD and dr. Ralph Garzia OD.

"diopter" (D) refers to the unit of optical power equal to the reciprocal of the focal length (in meters) of a given lens or portion of a lens.

"divergence" is the opposition to convergence and is the ability to rotate the subject's two eyes outward to view distant objects. This technology is required for remote activities such as watching blackboard at school, driving and watching television. In order to diverge, the opposite situation to near-triplet motion must occur, i.e. the eye diverges, accommodation is inhibited, and the pupil dilates slightly.

"e-value" refers to a measure of corneal eccentricity, with zero values representing a perfect spherical cornea. A negative e value represents a flat central region (oblate surface) with a steep intermediate periphery, while a positive e value represents a steep central region (prolate surface) flattened radially outward.

"fixation difference (fixation disparity)" is the tendency of the eye to drift in the direction of strabismus. Strabismus or strabismus is defined as a condition in which the eye in its primary position or in its motion remains at a fixed point of view only under pressure, and refers to a non-fusion vergence state. Solid parallax refers to a small misalignment in which the image drifts slightly from the corresponding point, but remains in the fovea under normal fusion and binocular vision conditions. Misalignment may be vertical, horizontal, or both. Although strabismus prevents binocular vision, fixation disparity maintains binocular vision, although it may reduce the patient's level of stereoscopic vision and cause visual fatigue.

A "focal point" is a point where rays originating from an object or direction converge, for example, by refraction.

The "fovea" is the portion of the eye that is centered in the macular region of the retina. Fovea is responsible for clear central vision, which is necessary in any activity where human reading, watching television or movies, driving, and visual details are critical. The human fovea has a diameter of about 1.2mm to 1.5mm and subtends a viewing angle of about 4-5 degrees (2 deg. to 2.5 deg. on each side of the optical or visual axis). The Best Correctable Vision (BCVA) is about 20/20.

The "front" of a lens refers to the surface through which light enters the lens in its normal and intended use. For example, for a contact lens, the front face is the outward facing surface that contacts air when worn on the subject's eye.

"binocular single vision" is a locus of points in space that have the same difference from fixation. This can in theory be defined as the point in space projected onto corresponding points in the two retinas of the subject (i.e. projected onto anatomically identical points). "theoretical binocular single vision" or "Veith-Muller circle" refers to a theoretical geometric circle passing through the optical centers of both eyes, through which a point located on the circle adjacent to the fixation point theoretically falls on the corresponding retinal point. The theoretical binocular single vision must be a circle passing through the fixation point and nodes of both eyes. An "empirical binocular single vision" is an ellipse determined through experimentation of the optical centers of two eyes, by which points on the ellipse adjacent to the fixation point are perceived as stimulating the corresponding retinal points. The shape of the empirical binocular vision field deviates from the theoretical binocular vision field.

"image shell" refers to a generally concave region of clear focus produced by an ocular refractive system wearing corrective lenses (contact lenses or spectacles).

An "intraocular lens" (IOL) is an intraocular lens implanted in an eye that may replace or coexist with the lens of the eye.

"lag of modulation or modulation lag" is the difference between the modulation stimulus (+2.50d at 40cm target) and the modulation response (focus), i.e., the stimulus is closer than the response. Modulation lag= (modulation stimulus-modulation response), this value is positive.

A "regulated lead or regulated lead (accommodative lead)" is the difference between a regulated stimulus and a regulated response, where the response is closer than the stimulus. Modulation lead= (modulation stimulus-modulation response), this value is negative.

"lens" refers to an optical element that causes light to converge or diverge, and in particular to a device that is not a tissue or organ of a subject.

"macula protection" is a visual field loss that maintains vision in the center of the field of view, also known as the macula. It occurs in a person with a hemisphere of the visual cortex damaged and occurs simultaneously with bilateral ipsilateral blindness (homonymous hemianopia) or ipsilateral quadrant blindness (homonymous quadrantanopia). Visual field testing may be used to determine macular protection. Macula is defined as the region around the center of the field of view by about + -8 degrees. For patients considered to have macular protection, vision in areas greater than 3 degrees must be maintained because involuntary eye movement exists between 1 and 2 degrees.

"macular division (macular splitting)" is the opposite effect of "macular protection" in which vision is lost in the central half of the visual field.

"meridian" generally refers to an imaginary line extending along a curved surface of a lens. A "horizontal meridian" is a line that runs through a plane parallel to the surface (e.g., floor or ground) supporting the lens when the user of the lens wears the lens. A "vertical meridian" is a line extending through a plane perpendicular to the horizontal meridian and generally parallel to the sagittal plane of the user wearing the lens.

"NSUCO eye movement test" is a method developed by experienced clinicians through NSUCO (university of North and southeast of North, visual optics), to evaluate fine visual motor skills. This test requires only minimal equipment.

"ocular defocus" refers to the progressive forward defocus (shorter focus, i.e., myopic defocus) or backward defocus (longer focus, i.e., hyperopic defocus) of the eye's image focus outward from the parafovea (Para-fovea) center to the peripheral portion of the retina. Forward (myopic) or backward (hyperopic) defocus is a combination of the optical system and the shape of the eyeball. Presbyopic defocus with a shorter peripheral retinal shell is more common in myopic eyes. Myopic defocus of the eye with a longer peripheral retinal shell is more common in presbyopia.

"eye movement dysfunction" is a problem in the eye movement system with one or more problems of fixation, saccadic eye movement, and/or tracking eye movement. Such dysfunction prevents effective reading skills and may also limit or reduce reading understanding.

When referring to light passing through the lens, "on-axis" refers to a direction substantially parallel to the optical axis of the lens. When light from an object enters the lens from a direction substantially at or parallel to the optical axis, the object is referred to as a center object, and the image formed by the lens is referred to as a center image. In the ocular vision system, the on-axis image is conjugated to the concave portion of the retina (as shown in fig. 1).

When referring to light passing through the lens, "off-axis" refers to a direction that is not substantially parallel to the optical axis of the lens such that incident light entering the lens deviates from the optical axis by an angle greater than zero. In the ocular vision system, the off-axis image is conjugated to regions of the retina outside the foveal portion, particularly paracentric or near foveal regions (as shown in fig. 2). If the incident light enters the optical device at an angle exceeding 2 degrees and within 10 degrees from the optical axis of the system, the off-axis may be further defined as "para-axis".

By "optical axis" in an optical device (e.g., a lens) is meant a line along which there is some degree of rotational symmetry such that the device is radially symmetric about the line.

"p-value" (p) is defined by the equation p=1-SIGN (e)/(e) ² An amount derived from the e value (e), wherein SIGN represents the same positive or negative value as the e value, i.e. if e<0, SIGN (e) = -1, and if e>0, SIGN (e) = +1. The prolate cornea surface has a p-value of less than 1.0 and the prolate cornea has a p-value of greater than 1.0. The p-value for a perfectly spherical cornea is 1.

"Parnoulli fusion area" refers to an area in front of or behind the binocular vision where binocular single vision exists. Which is narrowest at the fixation point and becomes wider at the periphery (see fig. 11). In the area of the panum, which includes the binocular vision, a single image is visible through a properly functioning eye, while outside the area of the panum, either the front or the back, a double image is visible. All objects outside the panum area produce double vision.

The "parafovea" is the central region radially outward to 0.5mm each side and surrounding the fovea, where the ganglion cell layer consists of more than five rows of cells and the highest density cone. The outermost paracentric region subtends a viewing angle of about 8-10 degrees (4 deg. to 5 deg. on each side of the optical or visual axis). The Best Correctable Vision (BCVA) in this area may be 20/50 (0.4 logMAR) up to less than 20/20 (0 logMAR).

"perifovea" is the outermost region of the macula found at 1.5mm on each side and surrounding the parafovea, where the ganglion cell layer contains two to four rows of cells and is the region of less than optimal visual acuity. The most peripheral near foveal region subtends a viewing angle of about 18-20 degrees (9 deg. to 10 deg. on each side of the optical or visual axis). The Best Correctable Vision (BCVA) in this region is between 20/50 (0.4 logMAR) and 20/100 (0.7 logMAR).

The "peripheral refraction" of the eye can be measured with a wide field of view (or open field) refractometer (such as Shin-Nippon NVision-K5001 or Grand Seiko WR-5100K) that has a wide field of view window and allows the subject to relax during the measurement by naturally looking at the window with both eyes and looking at it at any distance and direction.

"Phoria" is a misalignment of eyes that occurs only when binocular viewing is broken and both eyes are no longer viewing the same object. When a person is tired, misalignment of the eyes begins to occur and therefore does not exist at all times. The crouching can be diagnosed by performing a covering/covering test.

"Readalyzer/Visasraph" is a hardware and software package. It includes goggles that fit precisely onto the patient's face for scanning small movements of the eyes as they aim at different visual signals on the test page. The goggles are connected to a computer running software that provides data analysis, display and storage.

"optical power" or "power" is the degree to which a lens converges (or diverges) light. The power of the lens is equal to the reciprocal of its focal length (in meters), or d=1/f, where D is the power (in diopters) and f is the focal length (in meters). "positive power" refers to the degree of convergence of the light that focuses the near object with the lens, while "negative power" refers to the degree of divergence of the light that focuses the far object.

The "retinal correspondence" is Normal Retinal Correspondence (NRC) or Abnormal Retinal Correspondence (ARC). NRC is a binocular condition in which the two fovea work together as corresponding retinal spots, with the result that the image is fused in the occipital cortex of the brain. ARC is binocular sensory accommodation to compensate for strabismus. The non-foveal and non-foveal (typically paracentric) points of the non-decentered eye work together to allow for binocular fusion of single vision.

"rigid contact lens" refers to a lens whose surface does not change shape when placed on the eye to assume the contour of the corneal surface. Rigid contact lenses are typically made of PMMA [ poly (methyl methacrylate) ] or of gas permeable materials such as silicone acrylates, fluoro/silicone acrylates and cellulose acetate butyrate, the major polymer molecules of which typically do not absorb or attract water.

The "SCCO eye movement test" is a method developed by SCCO (institute of vision, california, south) for evaluating fine eye movement skills, performed by experienced clinicians. Tests were given a score of +1 to +4 for fixation maintenance, catch-up and saccade.

The "Shack-Hartmann system" may be used to measure ocular crystal aberrations. The high resolution visual display displays the light spots that a user views through the array of small mirrors. The user then manually moves the displayed spot (i.e., the generated wavefront) until the spot is aligned. The magnitude of the deviation provides data to estimate first order parameters such as radius of curvature and thus errors caused by ambient defocus and spherical aberration.

A "soft contact lens" is a lens formed of a material whose surface generally assumes the contour of the corneal surface when placed on the cornea. Soft contact lenses are typically made of materials such as HEMA (hydroxyethylmethacrylate) or silicone hydrogel polymers, which contain about 20-70% water.

"eyeglasses" or "eyeglasses" refer to frames with lenses that are worn in front of the eyes. The frame is typically supported on the bridge of the nose and by arms that rest on the ears.

"spherical aberration" refers to the deviation of a device or portion thereof from the focal point of an ideal lens at a point where all incident light rays are focused on the optical axis.

"stereoscopic" refers to perceived depth based on visual information derived from both eyes. The human eye is located at different lateral positions on the head, resulting in two slightly different images, the main difference being the relative horizontal position of the subject projected onto the fovea of the eye. The positional differences are referred to as image differences and are processed in the visual cortex to produce depth perception. Stereoscopic vision requires binocular fusion, but vice versa.

As used herein, "inhibition" refers to an inhibition mechanism that produces a complete or partial elimination of one of the two monocular images observed by both eyes. The adaptive value of this mechanism is to avoid confusion or double vision. "Intermittent Central Suppression (ICS)" is a defect in normal binocular vision that results in repeated intermittent loss of visual sensation in the central region of vision, with central vision of either eye "on and off" while maintaining peripheral fusion. The monocular inhibition during binocular fusion is characterized by a transient inhibition cycle limited to a central 2-3 degrees. Monocular inhibition may last for about 2-3 seconds, followed by fusion of both eyes for 2-3 seconds, and inhibition may be for 2-3 seconds for the same or the other eye. The ICS may occur in one eye as a constant ICS or alternately in both eyes as alternating ICS.

A "translating" bifocal or multifocal contact lens is a lens having at least two separate zones or regions for distance vision and near vision, respectively.

"oblique eye (tropia)" is a misalignment of the eyes that is always present. Large angular misalignments are apparent even when the eyes are open and are attempting to work together. Oblique eyes are resting positions that eyes go to when covered or when fusion is broken due to repeated and alternating covering of each eye.

"visual acuity" refers to the sharpness of focus provided by a particular optical system (e.g., the lens and/or cornea of the eye).

The "viewing angle" is the angle subtended by the light with respect to the viewing or optical axis, preferably measured from the principal plane.

"visual axis" refers to a straight line extending from the subject through the center of the subject's pupil to the foveal region of the retina in the human eye.

"visual efficiency" is the ability of the eye to track, converge and focus quickly. The evaluation of visual efficiency skills consists of four systems including an eye movement system, an accommodation system, a vergence system, and a sensory system. Proper visual processing of visual information requires visual efficiency. Having difficulty in this area is often referred to as a visual efficiency problem.

"vergence dysfunction" is a problem with vergence systems in that, for simultaneous movement of both eyes in opposite directions, single binocular vision is obtained or maintained as the distance of the object changes. There are several types of vergence dysfunction, involving one of the following diagnoses: (1) fusion vergence dysfunction; (2) insufficient Convergence (CI); (3) basal external strabismus; (4) excessive divergence; (5) Excessive Convergence (CE), (6) basal esophagitis; and (7) insufficient divergence.

"visual information processing skill" refers to the term that the brain uses and interprets the ability of visual information from the surrounding world of a person. The process of converting light energy into meaningful images is a complex process facilitated by many brain structures and advanced cognitive processes.

The terms "comprises" and variations of the term, such as "comprising" and "including", are not intended to exclude other additives, components, elements or steps. The terms "a," "an," and "the" and similar referents used herein are to be construed to cover both the singular and the plural, unless the context clearly dictates otherwise.

Equation(s)

The e-values for the horizontal and vertical meridians of the lens can be determined using the following formula:

1.R _p Is the radius of curvature at the peripheral distance "d"; r is R _c Is the radius of curvature of the center; d is the distance from the peripheral point to the center of the lens. E is the eccentricity; p is the p value.

(equation 1.1)

E＝SIGN(R _p -R _c )*SQRT(ABS(R _p ² -R _c ² ))/d

(equation 1.2)

p＝1-SIGN(E)*E ²

(equation 1.3)

R _p ＝SQRT(R _c +SIGN(E)*d ² e ² )

2. Along axis X ^o The non-uniform rotating aspheric ADF region of (a) can be formulated as:

E _h is a predetermined level (0-180 degrees) e value; _v Eis a predetermined vertical (90-270 degrees) e value; HR (HR) _p Is the radius of curvature at a point radially outward along the horizontal axis by a distance "d"; VR (virtual reality) _p Is the radius of curvature at a point radially outward along the vertical axis by a distance "d"; XR (X-ray diffraction) _p Is along axis X ^o Radius of curvature at a point radially outward by a distance "d"; _x Eis an axis X ^o E value of (2);

HR is calculated using equation 1.3 _p And VR (VR) _p ：

HR _p ＝SQRT(R _c +SIGN(E _h )*d ² E _h ² )

VR _p ＝SQRT(R _c +SIGN( _v E)*d ² _v E ² )

(equation 2.1) XR _p ＝HR _p +sin(X ^o ) ² *(VR _p -HR _p )

Equation 1.1 is applied to derive E _x ：

(equation 2.2) E _x ＝SIGN(XR _p -R _c )*(ABS(XR _p ² -R _c ² )) ^1/2 /d

Visual efficiency

Visual efficiency is the ability of the eye to track, converge and focus quickly. Proper visual processing of visual information requires visual efficiency. Visual acuity, ametropia, ocular motility, accommodation, and binocular vision together are all important contributors to visual efficiency. Abnormalities or dysfunctions in one or more of the above-described functions may affect visual attention and induce learning-related visual problems. Visual efficiency problems, especially binocular dysfunction such as insufficient Accommodation (AI) or insufficient Convergence (CI), can cause eyestrain or asthenopia, which may be one of the causes of rapid myopia progression.

There has been a great deal of research on the relationship between visual efficiency and reading-learning performance. The most well known case analysis system for visual efficiency is the optometry expansion program (OEP-21 point) analysis, the test of which is classified by digital code. Some other analytical and clinical criteria were proposed to aid in making decisions. OEP analysis tests refractive, strabismus, vergence and accommodation systems at both near and far distances. The comprehensive evaluation should also include examination of the eye movement and sensory system.

Techniques for measuring visual efficiency are well known to trained Eye Care Practitioners (ECPs), particularly behavioural optometrists or ophthalmologists (OD/OMD). The most important goal of human visual efficiency is to maintain the spatial relationship of the alignment and focus of the two eyes to form a single fused sharp image at all distances (near and far). Diagnosis and classification of visual efficiency abnormalities or dysfunctions is typically performed by comparing measured functional data with standard clinical data for the corresponding project. The relative sizes or ranges in some of the measurement projects also require cross-checking with clinical criteria evolving from the graphical analysis of OEP-21 points to help quickly assess whether there is a vergence disorder or a regulatory disorder. Accepted normative clinical data and visual efficiency cross-checking criteria (including but not limited to the Sheard standard and the Pervical standard) are well known to the skilled ECP.

In addition to examining accommodation and vergence data to assess whether there are possible visual efficiency problems, the assessment of the sensory system can more directly gauge the quality of binocular vision. Clinically, eye care professionals typically evaluate the sensory system by examining binocular fusion, differences in fixation, retinal correspondence (ARC or NRC), inhibition, intermittent central Inhibition (ICS), and three-dimensional stereo vision.

Strabismus (tropia) or strabismus (strabismus) is a condition in which the eyes are not properly aligned with each other when looking at an object. This condition may exist intermittently or continuously. The eyes that are held on the subject may alternate between eyes or may remain unchanged in one eye. Deviations may exist intermittently or continuously. Strabismus is a prominent binocular abnormality, but generally does not show significant visual efficiency problems. The sensory system of strabismus is typically adapted by suppression or ARC to eliminate confusion so as to not interfere or interfere only little with reading tasks.

On the other hand, the non-strabismus visual efficiency problem is not apparent without significant eye deviation, but they can profoundly impair reading understanding and school performance. Non-obvious binocular dysfunction is often overlooked or misdiagnosed as attention deficit disorder (ADD/ADHD) or dyslexia and misses the opportunity for early detection and correction.

The experienced ECP can diagnose non-strabismus visual efficiency problems by conducting a comprehensive visual inspection including examining eye health and visual acuity with refraction, as well as an assessment of visual efficiency skills of the eye's ball movement system, accommodation system, vergence system, and sensory system. For some underdeveloped children, their vision processing skills may be explored to find a perceived lack of skills. If a non-strabismus visual efficiency problem is found, the child may need to consult a behavioural optometrist or an ophthalmologist for further management. The treatment strategy may include prescribing a pair of glasses or contact lenses for correcting refractive errors, accommodating problems, and/or compensating for strabismus deviation angles. Refractive errors and accommodation problems may require positive or negative spherical power to correct or compensate for defects, while spherical mirrors or prisms may be used to aid or compensate for strabismus off-angle or vergence dysfunction. The practitioner can determine the spherical power or prism power by manipulating the measured angle of view, accommodation, vergence, and most importantly the type of visual efficiency problem determined in the integrated inspection. The determined spherical or prismatic power for compensation may be valid only temporarily or within a limited distance, e.g. only for the length of the arm. This is because the power provided by compensation is typically used to relieve visual stress rather than to improve or correct efficiency problems. The required compensating spherical power or prism power is typically different for distance and near distances. Because of the smaller need for accommodation or power of convergence with the aid of compensation spectacles, the eye can accommodate new angles of deviation and the dysfunction worsens over time.

Visual therapy (visual training or "VT") is a treatment option for patients identified as inattentive due to visual efficiency issues, particularly those related reading/learning difficulties and behavioral issues. The treatment may be defined as utilizing behavioral modification and biofeedback designed to re-arrange conditions, allowing new insights and facilitating efficient, effective and easy alternative methods of eye learning. VT will require office and home training courses. Improvement typically requires at least 3 months. After completion of the initial training session, the learned skills may decline and require periodic intensive training.

Compensatory spherical or prismatic spectacles or contact lenses can help visual efficiency by improving binocular image sharpness to better center blend in the foveal region of the retina, which is considered the primary region of the sensory system, to have a blended clear binocular vision. Positive spherical power is often added to help the accommodation system sharpen near vision at arm distance, such as presbyopia or under-Accommodation (AI) near vision. The added negative or positive spherical power can also change the vergence system by changing the accommodation convergence to improve the divergence angle and binocular fusion range. If spherical power is added to the lens to improve visual efficiency, the wearer may need two pairs of lenses, one for near distances and one for far distances. Alternatively, the patient may use a pair of bifocal or multifocal spectacles or contact lenses for daily work or school use.

Compensation prisms are often incorporated into eyeglasses to assist the vergence system with excessive divergence angles, such as fusion vergence dysfunction or insufficient Convergence (CI), at either long or short distances. The prism power is not specified to improve the vergence system or straighten the eye, but rather, it is added to move the entire image horizontally or vertically into the fovea of the binocular image off the retina of the eye to facilitate fusion with ease. The required relief prism power is typically different for long and short distances, so that the patient may need to change glasses when looking at different distances. This is very inconvenient for daily life, especially in schools. The relief prism neither compensates for the strabismus offset nor improves the vergence system, but satisfies the sensory system to achieve better center fusion at certain distances. The angle of squint may increase with progressive adaptation to the increasing prism and recurrence of dysfunction and visual fatigue may occur, requiring more prism to alleviate symptoms.

Spherical and prismatic spectacles may be combined to improve the sensory system and allow the foveal images to be fused more easily. While Vision Training (VT) can extend the fusion range of the extraocular muscles to maintain central fusion without disrupting the image. In other words, VT is used to train extraocular muscle and brain control to compensate for strabismus angle in order to better maintain binocular foveal fusion, just like a prism, whereas VT does not generally improve strabismus angle. The improved regulation after successful VT may be degraded in the event of irregular augmentation, and the sensory system may adapt itself in abnormal situations by some form of inhibition to relieve eye fatigue and confusion.

Patients with visual efficiency problems can adapt to dysfunction in several ways if not found and addressed correctly. The most common adaptation to children with visual efficiency problems is to avoid near-near tasks, which may be considered as attention deficit (ADD/ADHD) or dyslexia in schools. Another adaptation is to suppress one eye and view with one eye at a time. This phenomenon is involuntary and may be continuously inhibited in one eye or alternated between the two eyes.

Myopia may also progress more rapidly with accommodation to vision efficiency problems, as higher myopia may alleviate heavy convergence and/or accommodation requirements at arm distance for near-distance tasks. If inhibition continues to occur in one eye, myopia in the viewing eye (non-inhibited eye) for near distance tasks may progress faster than the other eye and become diopter-poor. If a more myopic eye is seen more clearly than the other eye when performing near tasks, developing refractive error can avoid double vision where vision efficiency issues are involved. Thus, myopia and refractive error may be an adaptation to the problem of visual efficiency. If we ignore the underlying visual efficiency problem and only compensate for induced errors such as myopia or refractive error, the induced errors will quickly worsen, thereby reducing the newly adapted compensation force. Myopia with insufficient Convergence (CI) may progress rapidly is not uncommon as children are unable to avoid the heavy close range tasks in schools. Myopia is an adaptation to the heavy convergence and accommodation demands of AI or CI situations, whereas a new pair of glasses for hyperopia breaks the adaptation, then myopia must progress further to establish a new adaptation for less heavy vision demands at arm distance. The same situation for the CI case results in accommodation for refractive error, where a more myopic eye is typically used for near distance tasks and for less heavy convergence needs, reading is done with only one eye. If a pair of glasses were designated to fully correct refractive error without correcting the CI, the refractive error could be increased to achieve a new accommodation for monocular vision, which requires less effort for the CI patient to read and work at arm distance. For those CI cases, myopia and refractive error can progress rapidly with heavier close work if the underlying visual efficiency problem is not properly found and corrected.

Currently, binocular dysfunction is analyzed by challenge adjustment systems and vergence systems with spherical and/or prismatic lenses to determine the power range and compensate for the defect with spherical and/or prismatic lenses. Visual training is a conditioning training (VT) that teaches the patient to perceive a stimulus and signal the occurrence of an appropriate response. We are still unaware of the physiological or anatomical sources that can be directly corrected to permanently cure most vision efficiency problems. The most common problems with vergence systems are insufficient Convergence (CI), with prevalence of 2-17%, average 13%, low AC/A ratio, high external strabismus at close distances, reduced positive (vergence) vergence range and possible insufficient Accommodation (AI). When prescribing eyeglasses for CI patients, adding additional power to compensate for accommodation lag to aid near vision can drive the eye outward and increase near distance external strabismus. The AC/A ratio of CI is typically lower than normal (3/1-6/1).

The foregoing binocular assessment, compensation lenses, and VT for visual efficiency problems are all intended to correct for the fusion or range of motion of foveal images. The new finding is that an increased positive power for only the peripheral portion of the contact lens can immediately and significantly reduce the external strabismus at near distances while also reducing the accommodation lag at near distances without compromising distance vision. That is, we can justify the spatial relationship of all distances to correct visual efficiency problems by manipulating the peripheral eye defocus of the image, which has never been taught in the traditional concept of eye collaboration.

Another finding is to use the above-mentioned contact lenses for over Convergence (CE) conditions to improve presbyopia (inward deviation) at near distances. CE is characterized by a higher AC/a, higher implicit strabismus, and reduced negative (sporadic) fusion range, which is almost contrary to the CI case in traditional diagnostic and repair classifications. The same Center Distance (CD) multifocal lens can also immediately restore the spatial relationship of the CE patient, which is as effective as the CI patient. In both CI and CE situations, the sensory system can be significantly improved, reducing or eliminating fixation differences and associated presbyopia, to reduce or eliminate the prism power required for binocular fusion.

In order to treat CI and CE conditions using CD multifocal lenses, we need to know how the multifocal lenses alter the sensory system for binocular fusion at the peripheral portions of the eyes. To understand binocular fusion we need to know the single vision fusion region of panum defined by theoretical and empirical binocular single vision. Binocular fusion occurs in only a small portion of the visual space surrounding the eye fixation. Passing through the fixation point in the horizontal plane is a curve known as the experience level binocular vision. There is also an empirical vertical binocular single vision that is tilted from the eye above the fixation point and oriented towards the eye below the fixation point. The horizontal binocular single vision and the vertical binocular vision mark the centers of the visual single volumes. Within this thin and curved volume, objects closer and farther than the single vision of both eyes are considered to be a single object. This volume is called the bernoulli fusion zone, outside of which a double vision occurs.

Conventional visual acuity and binocular fusion are defined for the foveal retina with optimal correctable vision for binocular fusion and stereoscopic vision. In fact, if a person has strabismus and is unable to fuse binocular central images, there will be multiple vision due to foveal area, monocular central suppression or amblyopia for diagnosis and management. The resolution of the peripheral retina is typically much lower, with much poorer correctable vision. Qualitative or quantitative determination of peripheral binocular fusion is also difficult, so peripheral vision is generally ignored and considered unimportant to binocular fusion. However, although the central field of view has a very sharp sharpness of 20/20 or better, the central field of view is only 1% of the total field of view, so that the peripheral 99% field of view and its fusion can play an important role in maintaining binocular fusion for eye coordination. Models of both eye vision and the bernoulli fusion area provide the best support for the importance of peripheral fusion. The area of the panum is narrower at the fixation point (fovea) and progressively widens toward the periphery (peripheral retina). When we look at the target in the center and fuse the binocular center image, we also need the binocular peripheral fields of view to fuse as widely as possible for better visual efficiency. The arrangement of the bernoulli fusion regions is an adaptation that facilitates peripheral fusion at lower resolutions of the peripheral retina. Oblique rays in the peripheral field enter the peripheral portion of the cornea to form an image at the peripheral portion of the retina. Oblique rays entering the peripheral part of the cornea will cause oblique astigmatism, which coincides with the horizontal meridian (J ₀ ) Rule (ATR) astigmatism and vertical meridian (J) ₉₀ ) The regular astigmatism in (a) is reversed. This is how the peripheral retina perceives a peripheral image for binocular fusion. Therefore, the characteristics of image perception and binocular fusion at the peripheral portion of the retina are very different from those of fovea, and it is more difficult to detect peripheral fusion with a technique of detecting central fusion.

High quality fusion for an effective sensory system should preferably have the clearest central field of view in the fovea and a more blurred toric (toric) peripheral field of view in the peripheral retina, and both fall within the bernoulli fusion zone for binocular fusion. Horizontal experience binocular single vision is critical for binocular fusion. According to the Hering-hillbrand deviation, the horizontal experience binocular single vision is flatter than the theoretical binocular single vision at shorter fixation distances and becomes convex for farther fixation distances. At shorter fixation distances, the horizontal experience binocular vision is a concave parabola that is flatter than a circle. At a given distance, called the attenuation distance (abathic distance), the empirical binocular single vision becomes a straight line. Finally, for fixation distances farther than the attenuation distance, the empirical binocular single vision is convex parabolic. In other words, the shape of the bernoulli mate zone is concave, straight or convex in different fixation planes.

Studies of the Paknoop fusion region typically employ geometric methods, including trigonometric analysis of visual axis and spatial angle. Whereas the accommodation or focusing system should not be neglected because the binocular single vision plane in space is determined by the convergence system and the accommodation system together to form a clear image of the entire retina in the binocular single vision space. The width of the bernoulli fusion zone, also known as the confusion of accommodation, corresponds to the angle of convergence of the two eyeballs. As the closer points are seen, the fusion area of the panum will become wider with greater image differences on the retina. That is, if the peripheral image skin is too blurred for the peripheral image to be fused within the pnum fusion area, the binocular fusion can be easily interrupted or compromised although the central fusion is complete. A closer viewing distance will result in a greater parallax and it is more difficult to maintain fusion.

The macular region, which is essentially the central 4-5 foveal region, protrudes into a different region of the visual cortex of the brain than the peripheral retinal region and is responsible for the macular protection that causes the visual cortex injury. This phenomenon also tells us that the center image and the peripheral image can be considered as two separate image shells for fusion. When using stereo image test motion fusion, we can realize that the center image remains fused with stereo vision, while the peripheral images in the outer frame break before the center image breaks. The central image shell is necessary for clear binocular and stereoscopic vision requiring precise accommodation, sensory fusion and motor fusion. While the peripheral retinal area outside the macula forms the peripheral image shell, which is important in the distribution and stabilization of binocular central fusion.

The shape of the eyeball, the optical system including the cornea and the crystal, and the retinal shells for forming images are different in the general population. The shape of the eye may change with physiological growth in young people (typically before the age of 7-9 years), where the physiological eye growth spreads almost equally in anterior-posterior and equatorial dimensions. Whereas myopic elongation generally expands along the anterior-posterior axis (axial elongation), elongation to the peripheral portion of the retina becomes smaller and smaller, with little or no elongation at the equator. Axial elongation with myopia progression can change more deeply the peripheral image focus in the peripheral retina. The axial elongation of myopia will end with a defocusing of the eye relative to hyperopia, progressively increasing outwardly to the peripheral portion of the retina if myopia is corrected with conventional single vision glasses or contact lenses. A commercially available autorefractor (e.g., shin-Nippon NVision-K5001 or Grand Seiko WR-5100K, COAS Shack-Hartmann aberrometer) can be used to objectively detect peripheral eye defocus on the human eye to map focus to desired on-axis and off-axis viewing angles. Studies using MRI (magnetic resonance imaging) have also found that peripheral hyperopic defocus correlates with retinal shell deformation as myopia progresses. The change in retinal curvature in highly myopic eyes is more pronounced in the horizontal meridian than in the vertical meridian, especially in the temporal lobe retina, which can account for the pronounced hyperopic peripheral defocus in the image shell.

If the subject falls outside the bernoulli fusion area of the person's fixation point, the subject's image will double and fail to fuse, which is known as physiological double vision and may occur at the central or peripheral field of view. The fusion area of the panum is narrower at the center and becomes wider at the peripheral field of view, which corresponds to lower resolution and is opposite to the regular astigmatic image at the peripheral portion of the retina. The peripheral retina has been adapted to fuse blurred and distorted images formed by oblique rays entering the peripheral portion of the cornea. When we binocular fixation at the near point for reading, fovea (4-5 °) is used for fixation and perception of codes, while paracentric, near fovea and peripheral retina will aid repositioning and binocular fusion in saccadic eye movements. Saccadic eye movement is a rapid and conjugate eye movement that moves the fixation center from one part of the field of view to another. Eye saccades are mainly used to direct gaze towards an object of interest. Binocular vision for reading is not a static condition, but a dynamic process in which the eyes must be quickly repositioned and paused for several seconds to focus and binocular fusion to obtain a clear image, thereby repeatedly perceiving words.

The conventional concept defines normal binocular vision in free space by coordinating the accommodation system for focusing at all distances and the vergence system for targeting objects for binocular fusion, which are considered for foveal image fusion only. The fovea subtends only a 1-2 viewing angle on each side of the visual axis, which is approximately 1% of the total visual field. While fovea is very important for clear vision with optimal resolution, it is not wide enough to maintain binocular fusion. It must be a peripheral field of view that can be fused first to precisely align the central field of view. The wider the image shell falls within the bernoulli fusion area for fusion, the more accurate and efficient the center image will be, enabling precise fusion of the clear center image. If a wide peripheral image is focused forward (shorter focal length) or backward (longer focal length) to the retinal shell and the fusion area of the bernoulli is not met, the eye will be forced to look for more or less distant fixation and focal points to restore peripheral fusion and eliminate presbyopia or confusion. The farther or closer fixation distance required for peripheral fusion may change at least one of the accommodation system or the vergence system and cause blurring or interruption/impairment of the central image fusion. If binocular central fusion is disrupted, double vision or suppression will occur. If the center fusion is impaired but not interrupted, there will be ICS (intermittent center suppression), solid disparity, or blurring of the center image. The damaged image may still fall within the bernoulli fusion area for fusion, but the image quality will be poor, detectable as differences in fixation, ICS, accommodation lag or cramps in the eye examination.

That is, the mismatch of the central and peripheral image shells may drive binocular re-fixation through the vergence system and the accommodation system for the fusible state to prevent double vision. The cost of re-fixation is a foveal image disturbance of poor visual quality, which may show fixation differences, ICS or visual blur/fluctuation. Poor visual quality may in turn require frequent refocusing by the accommodation system, moving the head forward/backward, inducing eye movement dysfunction, eye fatigue or rapid myopia progression, which are common symptoms of visual efficiency problems.

In conventional visual efficiency tests (e.g., OEP-21 spot inspection), deviations of fixation/focus from the observed target will be detected as abnormal epistrabismus/epistrabismus (# 8 and # 13), unsatisfied Sheard/Percival criteria with abnormal relative accommodation (# 20-PRV or # 21-NRA), relative vergence (# 16A-PRV, #17A-NRV, #16B-PFV, # 17B-NFV) or increased accommodation hysteresis (MEM retinoscopy, # 14a-mesh and # 15a-mesh with unfused cross-bars, and # 14b-mesh and # 15b-mesh test with fused cross-bars). Deviations of the fixation point/focus point from the viewing target may also cause eye movement dysfunction, which may be measured using the NSUCO test, SCCO test, DEM ^TM Or ReadAlyzer/Visagraph.

In other words, the innovation proposes an anatomic-optical factor of the eye's eye shape and optical system that may cause visual efficiency problems, which can be measured and corrected by adjusting peripheral eye defocus either forward or backward using anti-defocus (ADF) optics to realign the image shell to match the wider retinal shell for better full-field fusion. Anti-defocus (ADF) devices better match the requirements of the retina from central outward to the bernoulli fusion area of the peripheral portion and further promote better central fusion to reduce or eliminate visual efficiency problems.

Myopia progression can be attributed to the same anatomical incompatibility in that peripheral image shells do not fit into retinal shells in terms of distance of the arms for reading, also a new innovation. Without being bound by a particular theory, it is possible that not only is optical stimulus controlling human eye growth as described in the prior art, but binocular fusion incompatibility may also be a major factor forcing the eyeball to change shape. Evidence is very common in children with CIs that their myopia may progress very rapidly, especially if the patient is forced to learn without avoidance of the CI's close range task. Once we prescribe an anti-defocus (ADF) contact lens for patient wear, their CI status is often significantly improved to obtain better center fusion without compensation prism or VT. Myopia progression can also be stopped or slowed considerably. The ADF lens according to the present invention realigns the image shell with the entire retinal shell to fall within the fusion zone of the panum and improves binocular fusion by precise fixation on the target, which further promotes central fusion and focusing, which can be detected by conventional visual efficiency testing as described above. Once the visual efficiency problem is corrected and eye fatigue is alleviated, rapid myopia progression may be slowed or stopped.

Another innovation is to use a series of ADF optics with progressive or progressive peripheral forward or backward peripheral focus to evaluate the degree of peripheral eye defocus in patients with vision efficiency problems and realign the image shells in the appropriate panum fusion area to normalize center fusion and focus. Along with the introduction of ADF optics, it is also desirable to monitor the evaluation of peripheral eye defocus. It is often difficult to directly detect peripheral eye defocus and peripheral image shell misalignment. Once the image misalignment is corrected by the ADF device, we can test foveal fusion or visual efficiency performance, which can be done by repeating OEP-21 point testing, or more conveniently, by monitoring solid parallax or binocular fusion/stereoscopic vision. The central fixation disparity inconsistency will be more properly realigned and the strabismus disparity can be reduced by improved relative vergence and/or relative adjustment, as described in OEP-21 point inspection. For candidates with eye movement dysfunction, the NSUCO test, SCCO test, DEM may be repeated before and after the ADF optic is worn ^TM Or readAlyzer/Visasagraph And the chemical conversion is improved. Preferably, the comparison is repeated after several days or weeks of wearing the device, so that there is time to initiate a new balance with a new optical system. The ECP can then switch and incorporate the detected defocus of the peripheral eye for the preferred spectacles or contact lenses.

There are several conventional ways to compensate for visual efficiency problems (e.g., CI and CE) using spherical lenses or prismatic lenses. The prismatic lenses do not correct for strabismus, but deviate the binocular image outward or inward by an off angle that allows binocular fusion with less effort, which may alleviate eye fatigue for some time, but the patient is often adapted to alleviate the prism and deviate more to show greater strabismus with symptoms and/or suppressed reproducibility. Spherical lenses can adjust and modulate the oblique bias indirectly through AC/a changes and improve central fusion. However, the spherical device may only work for a predetermined distance. If used for vision beyond a preset distance, the vision will become more blurred or the binocular fusion will be interrupted. In cases where visual efficiency problems are demonstrated due to misalignment of the image shell and retinal shell, the image shell may be modified with peripheral ADF optics to better fit into the fusion area of the panoum over all distances. Conventional methods of Vision Training (VT) correcting visual performance skills still help to further expand the scope of fusion and improve the fusion skills of individual candidates, while continuing to use ADF optics after training requires less training time or enhancement.

The shape of the peripheral retina determines how the image shell matches the retinal shell from center to periphery. The bernoulli fusion zone on the horizontal meridian follows a Hering-hillbrand deviation, which will be concave for short fixation distances and convex for far fixation distances. In other words, if the peripheral retinal shells have a relatively far-sighted eye defocus, the fixation distance must be away from the eye so that the image shells fall in the bernoulli fusion zone for fusion. Convex Hering-hillbrand deviations in distance also indicate retinal shape in axial myopia, i.e. retinal shells with progressive hyperopic defocus outward from the center. The fusion system for binocular fusion is driven by the peripheral retinal shells, while focusing or accommodation is driven by the fovea. It is known that in the case of far vision the focal length will be longer, and in the case of near vision the focal length will be shorter. In the present invention, hyperopic defocus has a longer fixation distance from the eye for binocular fusion and myopic defocus has a shorter fixation distance from the eye for binocular fusion.

The Hering-hillbrand deviation is concave at near distance and the concave bernoulli fusion zone also progressively widens toward the periphery, which can accept far-sighted peripheral eye defocus, while near-sighted peripheral eye defocus. On the other hand, the Hering-hillbrand deviation of the bernoulli fusion zone is convex at the distance and progressively widens peripherally, which can accept more hyperopic peripheral ocular defocus at the distance.

Visual efficiency correction

Myopic eyes typically extend along their anterior-posterior axis, have a longer axial length, the peripheral retina is less elongated, which can create hyperopic defocus, and blurred peripheral images are focused behind the retina, while concave images are in focus when corrected using spherical lenses. Peripheral eye defocus cannot be accommodated by accommodation or single vision optics because the foveal image will be changed and simultaneously fall out of focus. The eyes can accommodate peripheral eye defocus of the vergence system by fixation of the eyes at a greater distance (less convergence) to seek a greater distance but sharper peripheral image to achieve better peripheral fusion. Fixation at a greater distance for binocular single vision may not be perfect, but allows for better binocular fusion. After re-fixation, the center and peripheral images may fall within the Bernoulli fusion region for fusion, but will be substantially mismatched to display "fixation disparity" (exoFD), "intermittent center suppression" (ICS), or over-accommodation hysteresis. The model also accounts for the characteristics of insufficient Convergence (CI) with low AC/A ratio and excessive external strabismus with accommodation lag at near distance (MEM in OEP-21 Point exam, #14A and 14A-net, 15A, 14B and 14B-net, 15B). The shape of the eye suitable for the model is not limited to a myopic state. If the peripheral retinal shells have a relative hyperopic defocus for most peripheral image shells to focus more posteriorly to the retina and trigger less convergence to fixation at a greater distance for binocular fusion, the eye may simply be one of emmetropia, hyperopia, or myopia.

The opposite model accounts for excessive Convergence (CE) when the peripheral retinal shells have excessive myopic defocus. The presbyopic eye may have a short axial length and a relatively wide equator, which when corrected with a spherical lens, may create myopic defocus in which the blurred peripheral image is focused in front of the retina and the foveal image is in focus. The peripheral defocus of the eye cannot be adjusted by the accommodation system or relaxation of the single vision optical lens, as the foveal image will simultaneously come out of focus. The eyes can accommodate peripheral eye defocus of the vergence system by focusing the eyes at a closer distance (more converging) to seek a closer but sharper peripheral image for better peripheral fusion. Fixation at closer distances for binocular single vision may not be perfect for vision, but allows for better binocular fusion. After re-fixation, the center and peripheral images may fall into the panum fusion area for fusion, but should be substantially mismatched to display "fixed parallax" (esoFD), "intermittent center suppression" (ICS), or adjustment leads. The model also accounts for features of over Convergence (CE) with high AC/A ratio and MEM in close-up strabismus with over-adjustment (OEP-21 Point inspection, #14A and 14A-net, 15A, 14B and 14B-net, 15B). The shape of the eye suitable for the model is not limited to the hyperopic state. If the peripheral retinal shells have a relatively myopic defocus for most peripheral image shells to focus in front of the retina and trigger more convergence to fix at a closer distance for binocular fusion, the eye may simply be one of emmetropia, hyperopia, or myopia.

Referring to fig. 3-5, a peripheral anti-defocus (ADF) optic, such as a contact lens, spectacle lens or IOL, is provided with a central optic zone 20 having optical power for correcting distance vision, which subtends an angle of view of about 4-5 degrees at the center, corresponding to a 1.5mm fovea zone located about 22.6mm behind the cornea plane of the human eye. The adjacent outward portion of the optic also provides an anti-defocus (ADF) zone 21 with a shorter or longer focal length to move the peripheral image shell forward or backward, respectively, which focuses the image on the peripheral retina beyond the foveal distance zone corresponding to at least up to 4-5 degrees of the fovea (up to 10 degrees), near fovea (up to 20 degrees) and part of the peripheral retina of the eye 14.

The novel method of the present invention may be used to design a peripheral anti-defocus (ADF) device for diagnosing and correcting vision efficiency problems and controlling associated myopia. The central power of the optics for the foveal region of the eye 14 is always used for correction of distance vision. If the power of the peripheral ADF area 21 is more positive to bring the peripheral focus forward, it is referred to as a hyperopic anti-defocus (H-ADF) lens. If the peripheral ADF area 21 is more negative in power so that the peripheral focus is backwards, it is referred to as a myopic anti-defocus (M-ADF) lens. The H-ADF lenses can be used to test and correct visual efficiency problems, such as insufficient Convergence (CI), of the peripheral retina that are involved in presbyopic defocus. M-ADF lenses can be used to test and correct visual efficiency problems, such as excessive Convergence (CE), of the peripheral retina that involve myopic eye defocus. For other types of visual efficiency problems, the ECP may be tested with an M-ADF lens or an H-ADF lens to determine if the problem is caused by an image mismatch that may be corrected with a peripheral ADF lens.

A set of test lenses may be used to determine the defocus resistance (ADP) of a lens according to the invention. The test set may be a series of spectacle lenses or contact lenses having a central optical zone 20 for distance vision, wherein the contact lenses have a diameter of 0.5mm to 1.5mm, or the spectacle lenses have a diameter of 1.5mm to 4.0mm. The central optical zone 20 may be assigned any spherical power convenient for clinical use for adding power to correct hyperopia. The most common option is to apply "zero power" to the central optical zone 20, and the ADF region 21 is adjacent to and progressively outward from the outer edge of the central optical zone 20, and adds positive or negative power to the peripheral defocus resistance. The best mode of ADF region 21 is to have a progressive positive or negative power from the outer edge of central optical region 20. The progressive ADF area of the ophthalmic lens for an M-ADF lens may have a positive e-value (p-value < 1) on the front side or a negative e-value (p-value > 1) on the back side. And for an H-ADF lens, a negative e-value (p-value > 1) on the front side, or a positive e-value (p-value < 1) on the back side.

Progressive ADF area 21 may also be included in the contact lens. Referring to fig. 3 and 4, progressive ADF area 21 of the m-ADF contact lens has a positive e-value (p-value < 1) on front ADF area 21a with curvature 31a or a negative e-value (p-value > 1) on back ADF area 21 b. Progressive ADF area 21 of the H-ADF contact lens has a negative e-value (p-value > 1) on front ADF area 21a with curvature 31 a; or has a positive e value (p value < 1) on the back ADF region 21 b. However, progressive ADF area 21a is preferably disposed on the front face of contact lens 10, leaving the back face for mating with the eye surface. Contact lens 10 may be a soft contact lens, a rigid contact lens (less than 12.4 mm), or a scleral lens (greater than 12.5 mm), with soft contact and scleral lenses being preferred to achieve better centering with less eye movement.

The viewing angle, field size, and image size should be determined to determine how the incident rays form an image on the retinal shell for peripheral eye defocus. The visual or optical angle conjugated to the principal plane can be calculated by: θ=2×arctan (S/2D), where θ is the viewing angle; s is the linear size of the object; and D is the distance from the subject to the principal plane of the eye. For smaller angles, the image size or retinal area width conjugated to the principal plane of the human eye can be expressed by: the image size i= [ (2 x pi x d) x θ ]/360, where d is the distance from the principal plane to the retina, and θ is the subtended viewing angle of the object. Alternatively, it can also be estimated by the image size i= [2 x (arctan (θ/2)) × d ]. For a standard human eye of 22.6mm, the image or incident field should be conjugate anteriorly or posteriorly from a theoretical principal plane located approximately 5.6mm posterior to the anterior surface of the corneal vertex or 17mm anterior to the central retina. For every-3D myopia progression, the axial length may be extended by 1mm, which may also slightly increase the image size, which is generally not important for designing the device.

Furthermore, if the present optical device is a contact lens, the viewing angle of the retinal region may be conjugate to the width of the region on the contact lens or corneal plane that is 22.6mm in front of the fovea or 5.6mm in front of the principal plane. If the optical device is an ophthalmic lens, the viewing angle may be conjugate to the width of the area on the lens 12mm in front of the cornea, 17.6mm in front of the major plane, or 34.6mm in front of the retina. To conjugate the zone width to the viewing angle, one degree is 1/360 of a circle, which is conjugated to a 17.5mm zone within a 1 meter distance, or to a 7mm zone within a 40cm reading distance, or to a 0.31mm zone within a 17.6mm spectacle distance in front of the principal plane, or to a 0.1mm zone on the surface of the cornea or contact lens 5.6mm in front of the principal plane.

As shown in Table 1 below, the 4-5 degree fovea is conjugated with a 0.5.+ -. 0.1mm zone on the contact lens plane or a 1.55.+ -. 0.2mm zone on the lens plane. The paracentric 9-10 degree span is then conjugated to a 0.85±0.1mm annular region on the contact lens or a 2.6±0.3mm annular region on the lens plane. The near fovea spans 18-20 degrees conjugated with a 1.8 + -0.2 mm annular region on the contact lens plane or a 5.5 + -0.5 mm annular region on the lens plane.

TABLE 1

The region conjugated to the foveal region forms the central region, while the annular region conjugated to the paracentric and near foveal regions and a portion of the peripheral portion of the retina forms the ADF region on the optical device. The annular region is not limited to a circular shape. It may be of any shape, i.e. conjugated to each side of the viewing axis or optical axis for the desired viewing angle to have an anti-defocus function. Thus, it is very straightforward to design ADF optics to determine the forward or backward direction of eye defocus and quantify the defocus resistance (ADP) required to correct vision efficiency problems when testing for misalignment of the center and peripheral image shells.

In ophthalmic lenses for testing presbyopic defocus, the central optical zone is preferably zero power, 1.5mm to 4.0mm in diameter, and has annular H-ADF zones of 8mm to 12mm on each side of the central optical zone, with a total diameter of 18mm to 28mm for use at an apex distance of 12mm to 14 mm. The H-ADF region 21 may be made with positive power progressing radially outward and with negative e-values (p-value > 1) on the front side or positive e-values (p-value < 1) on the back side. The intensity of the anti-defocus (ADP) can be controlled with a gradient e value between ±0.1e and ±2.0 e. The zero power of the central optical zone 20 can be used above the correction power of the patient to test peripheral eye defocus without changing the correction power for distance vision.

An ophthalmic lens for testing myopic defocus, the central optical zone preferably being of zero power, having a diameter of 1.5mm to 4.0mm and having annular M-ADF zones of 8mm to 12mm on each side of the central optical zone, the total diameter being 18mm to 28mm, for use at an apex distance of 12mm to 14 mm. The M-ADF region 21 may have a progressive negative power radially outward and a positive e-value (p-value < 1) on the front side or a negative e-value (p-value > 1) on the back side. The intensity of the defocus power (ADP) can be controlled with a gradient e value between ±0.1e and ±2.0e. The zero power of the central optical zone may be used above the patient's corrective power to test peripheral myopic defocus without changing the corrective power for hyperopia.

In contact lenses for testing presbyopic defocus, the central optical zone is preferably zero power, 0.5mm to 1.0mm in diameter, and has 3mm to 4mm annular H-ADF zones on each side of the central optical zone, the central-ADF zone having a total diameter of 6mm to 10mm for the cornea. The H-ADF region 21 may have a positive power progressing radially outward and a negative e-value (p-value > 1) on the front face of region 21 a; or has a positive e value (p value < 1) on the back side of the region 21 b. Although ADF region 21a is included on the front surface of contact lens 10, the back surface is preferably adapted to only the corneal surface 12. The intensity of the defocus power (ADP) can be controlled with a gradient e value between ±0.1e and ±3.0e. The zero power of the central optical zone 20 may facilitate over-refraction with the test frame without changing the correction power for distance vision.

In contact lenses for testing myopic defocus, the central optical zone is preferably zero power, 0.5mm to 1.0mm in diameter, and has annular M-ADF zones of 3mm to 4mm on each side of the central optical zone, a central-ADF zone of 6mm to 10mm in overall diameter, for use on the cornea. The M-ADF region 21 may have a progressive negative power radially outward with a positive e-value (p-value < 1) on the front face 21 a; or has a negative e value (p value > 1) on the back surface 21 b. When ADF region 21 is included on front surface 21a of contact lens 10, it is preferable to adapt the back surface to only corneal surface 12. The intensity of the defocus power (ADP) can be controlled with a gradient e value between ±0.1e and ±3.0e. The zero power of the central optical zone 20 facilitates over-refraction with the test frame without changing the correction power for distance vision.

An inspection procedure to identify binocular dysfunction may be performed by the trained ECP to obtain the information required for diagnosis. A look-up table (table 2) may be provided to guide the inspection and record baseline visual efficiency data prior to introduction of the ADF lens.

TABLE 2

Feel that: FD [ ] (EXO, ESO) AF [ ] delta (BI, BO) 2.FVFD slope [ ]

3. Inhibition: far (W4D) [ ] near [ ]

The fusion ranges (# 10, #11, #16, # 17), the accommodation systems for accommodation lag (# 14, # 15), the accommodation power (# 19), the accommodation facilities, the sensory system for fixation disparity, the associated strabismus or ICS are the most important items for further evaluation of the anti-defocus effect. The sensory system is the most sensitive indicator when testing ADF lenses. If the sensory system does not show significant anomalies in the initial exam, the vergence system can be an optional indicator. If the initial inspection reveals an adjustment dysfunction that can be improved with the peripheral ADF device, the adjustment system may be a secondary indicator.

The ADF test lenses may be a series of spectacle lenses or contact lenses as described above. ADF eyeglass lenses with gradient ADP can be made from imprecise test lenses for use with test frames or from accessories to be mounted on similar devices in a phoropter or rotating disk for quick operation. Accessories mounted on the phoropter are preferred to more easily compare small changes between replacement lenses to very short time intervals and ensure that the eye passes through the central optical zone of the ADF spectacle lenses, which is critical in testing peripheral eye defocus. ADF contact lenses with gradient ADP for testing can ensure that the central optical zone is aligned on the visual axis, but the elapsed time for contact lens replacement will be longer and less convenient. The ADF spectacle lenses are preferably used for rapid measurements and ADF contact lenses are applied to confirm the anti-defocus intensity, which should be specified for improving the visual efficiency problem. The maximum effect may take days or weeks to develop. From ADP initially acquired with the above-described testing device, the ECP may prescribe that a pair of contact lenses be used at home for at least 2 to 4 weeks and the vergence, accommodation or sensory system is rechecked against baseline visual efficiency data to fine-tune ADP to optimally correct visual efficiency problems.

If a sensory system is available for the indicator, the process of checking for defocus of the eye is as follows. The fixation disparity card or device is placed at the test distance, the corrective power of presbyopic patient #7 or # 14a_net/# 14b_net is used as a control, then ADF spectacle lenses (central zone zero power) are introduced progressively from lower ADP (lower ± e value) to higher ADP (higher ± e value) above the corrective power, and the fixation disparity/associated strabismus is checked until it is stable zero disparity or has maximum normalization. Finally, binocular fusion/suppression was carefully examined at a distance to ensure that far vision was not impaired by the ADF lens, and the original eye defocus intensity thus determined was recorded. If the vergence system is used as an indicator, the near split privacy view may be monitored while continuing to introduce ADF lenses until #13 is reduced to the normal range (# 13), and the vertical split prism is removed and the fusion range is re-checked (# 16, # 17) to check it against the remaining privacy view for Sheard or Percival criteria (# 13). If the criteria are met or significantly improved, binocular fusion/suppression is carefully examined at a distance to ensure that the distance vision is not impaired by the ADF lens and the original eye defocus intensity thus obtained is recorded. The original eye defocus intensity can be used to select a pair of test ADF contact lenses with zero power on the central optical zone to immediately fine tune the residual eye defocus in the office. Alternatively, a pair of ADF eyeglasses or contact lenses may be opened and delivered to the clinic based on the original eye defocus intensity to fine tune the power and ADF intensity over several weeks. If Vision Training (VT) is performed and the accommodation or fusion range is changed, the process may also be repeated when fine tuning is required.

The peripheral anti-defocus device for correction may be a pair of contact lenses, spectacle lenses, orthokeratology lenses or intraocular lenses (IOL), while the preferred devices are contact lenses, especially soft contact lenses and scleral lenses which do not move very much upon blinking. The method and apparatus of the present invention may also be applied to orthokeratology to temporarily reshape the cornea or to set parameters in refractive surgery to permanently reshape the cornea to correct refractive errors together with peripheral eye defocus. The glasses do not move with the eyeball and it is difficult to align the center of the eye to the center region. If the ADF device is an ophthalmic lens, there should be a single vision center optical zone 20 of 2mm to 4mm for the pupil center, and an ADF zone 21 with a spherical curve having a focus forward or backward from the center optical zone 20. Alternatively, an aspherical curve having a predetermined + -e-value that gradually advances or retreats from the central region 20 in focus may be used. The ADF region 21 is an annular region radially outward from the outer edge of the central optical region 20. The vertical meridians of the ADF region 21 may be set to be less aspheric (a smaller positive e-value or a smaller negative e-value, respectively) than the horizontal meridians to achieve better visual quality. The ADF region 21 is preferably made to be a horizontal aspheric surface band while leaving a vertical meridian single view with zero e-value to meet the horizontal Hering-hillbrand bias for fusion. Two perpendicular meridians can be blended with progressively varying e-values to form a smooth optical surface.

The ADF contact lens may be rotated on the eye so that the area of the lens is preferably rotationally symmetric and the ADF area 21 of the contact lens may be a single vision annular area having a spherical curve with a focus that is focused more forward or backward than the central area, and preferably an aspherical annular area having a predetermined + -e value that is focused progressively forward or backward from the central area 20. The aspheric annular ADF region 21 may be radially outward from the outer edge of the 0.5mm to 1.5mm single vision center region, or alternatively, the two regions may be combined with the continuous curve e-value to prevent image jump at the junction. The vertical meridian of the ADF area 21 of the contact lens 10 may be made less aspheric (a smaller positive e-value or a smaller negative e-value, respectively) than the horizontal meridian for better visual quality. The ADF region 21 is preferably made to be a horizontal aspheric surface band while leaving a vertical meridian single view with zero e-value to meet the horizontal Hering-hillbrand bias for fusion. Two perpendicular meridians (0 degrees and 90 degrees) can be blended with progressively varying e-values to form a smooth optical surface. A stabilization structure (prism stabilizer), truncated (or dynamic stabilizer) would be required to align the anti-defocus zone to the right axis, a technique well known to rigid and soft contact lens manufacturers in producing toric rigid or soft contact lenses 10.

Myopia control

Conventional methods for myopia management or control generally suggest relief of accommodation by ciliary muscle paralysis agents (cycloplegics) such as atropine or by using bifocal spectacles with ADD power for near tasks. The peripheral ADF device of the present invention is useful in slowing the progression of myopia, i.e., myopia treatment. In the present invention, it is proposed that peripheral defocus resistance is a factor to correct the visual efficiency problem and promote binocular fusion by correcting the image shell mismatch. In cases where vision efficiency problems are not found or corrected, myopia may progress quite rapidly. Peripheral hyperopic defocus may cause insufficient Convergence (CI), peripheral myopic defocus may cause excessive Convergence (CE), and both cases may cause myopia. If the visual performance assessment finds a CI condition, a hyperopic anti-defocus (H-ADF) device may be applied to slow or stop myopia progression. If the visual efficiency assessment finds a CE condition, a myopic defocus-resistant (M-ADF) device may be applied to slow or stop the progression of myopia. The M-ADF lens of the present invention is similar to but different from a near Center (CN) multifocal lens. Conventional CN multifocal lenses have a central zone for near vision and a peripheral distance zone for distance vision, the central zone having a positive add power, the peripheral distance zone being adjacent to and radially outward from the central zone, the power of the peripheral distance zone being a smaller positive number or a larger negative number than the power of the central zone. The M-ADF lens of the present invention also has a central optical zone 20, but the power is used for distance vision without near add power, while the power of the outer M-ADF zone 21 is a Shenzhen smaller positive number or a larger negative number than the central optical zone 20 for defocus resistance and correction of myopic peripheral eye defocus.

Both CI and CE conditions can induce myopia progression with different mechanisms. In the present invention, myopia is believed to be caused by laborious binocular fusion, rather than directing peripheral defocus to the ideal optical state as in the prior art. The present invention well explains the study that shows that myopia cases with near-in-oblique (CE) can be improved for less myopia progression with peripheral retromultifocal contact lenses that will cause more peripheral hyperopic defocus, as opposed to, for example, that taught in U.S. patent publication No. 20070115431A1.

Thus, the binocular efficiency status of myopic cases is examined in the present method and tested with the H-ADF or M-ADF test set to determine peripheral eye defocus and ADP intensity for correction as described above. The practitioner can also prescribe ADF devices in empirical ADP for initial adaptation at home and fine tuning the lens design or starting VT within 1-2 months for residual anomalies. The empirical ADP of ADF area 21 is typically 1 to 1.5 diopters per prism for classical compensation. For example, if the CI case requires a 10 ΔBI (base inch) dimming prism at 40mm, the ADP of the experienced H-ADF contact lens 10 will be +10 to +15 diopters at the outermost edge of the progressive ADF area 21. A pair of empirical ADF contact lenses 10 can be assigned for use in the home and returned to diagnosis so that visual efficiency is re-assessed within 1-2 months and lens design, ADP or additional VT is fine tuned to further improve residual dysfunction. The optical device, either a pair of glasses or a contact lens, will then be used to correct the mismatch of the central and peripheral eye image shells for accurate binocular fusion and myopia management.

Defocus-preventing spectacle lens

An ophthalmic lens according to the present invention (as shown in fig. 10) has a convex front face with a spherical curved central optical zone 20 and an ADF zone 21. The concave back surface of the ADF spectacle lens is formed as a spherical, aspherical or toric lens to work in conjunction with the front central optical zone 20 to correct refractive errors, as is well known to spectacle lens manufacturers. The ADF area 21 may alternatively be designed on the back of the spectacle lens.

In an H-ADF spectacle lens, the central optical zone 20 is preferably a spherical power produced on the anterior (convex) surface with a diameter of 1.5mm to 4.0mm, and each side of the central optical zone 20 has an annular more positive H-ADF zone 21 of 8mm to 12mm with an overall diameter of 18mm to 28mm for use at an apex distance of 12mm to 14 mm. The ADP power difference between the central optical region 20 and the outermost portion of the H-ADF region 21 is between +1.00D and +20D. H-ADF region 21 may be made with progressive positive power radially outward on the convex front face of region 21, and with negative e-values (p-value > 1); or a positive e-value on the concave back (p-value < 1). The focal length of the H-ADF region 21 progressively shortens along the horizontal meridian to the shortest (power minimum or maximum plus) focal length at its outermost edge, while the vertical meridian forms a zero e value for single vision curvature with constant focal length. The horizontal and vertical meridians merge with progressively varying e-values to form a smooth aspheric surface. For forward (near vision) peripheral focusing relative to a baseline without an H-ADF lens, the magnitude of the anti-defocus power (ADP) can be controlled with a gradient e value between ±0.1e and ±2.0e. The actual ADP effect of the spectacle lens measured on eye 14 is a minimum of-0.50 diopters, more myopia (N10 and T10) at 10 degrees to each side of the fovea, and progressively increases to a minimum of-2.00 diopters (N20 and T20) at 20 degrees to each side of the fovea.

In an M-ADF spectacle lens, the central optical zone 20 is preferably a spherical power produced on the positive (convex) face with a diameter of 1.5mm to 4.0mm and has an annular more negative M-ADF zone 21 of 8mm to 12mm on each side of the central optical zone 20 with an overall diameter of 18mm to 28mm for use at an apex distance of 12mm to 14 mm. The ADP power difference between the central optical region 20 and the outermost portion of the M-ADF region 21 is between-1.00D and-20D. The M-ADF region 21 may be made with a progressive negative power radially outward on the convex front face, with a positive e-value (p-value < 1), or with a negative e-value (p-value > 1) on the concave back face. The focus of the M-ADF region 21 progressively lengthens along the horizontal meridian until the longest (power maximum minus or minimum plus) focal length at its outermost edge, while the vertical meridian forms a zero e value for single vision curvature with constant focal length. The horizontal and vertical meridians merge with progressively varying e-values to form a smooth aspheric surface. The intensity of the defocus-resistant power ADP can be controlled with a gradient e value between ±0.1e and ±2.0e. The actual ADP effect of the spectacle lens measured on eye 14 is a minimum ± 0.50 diopters of distance vision (N10 and T10) at 10 degrees from each side of the fovea and progressively increases to a minimum ± 2.00 diopters (N20 and T20) at 20 degrees from each side of the fovea.

Defocus-preventing contact lens

Fig. 3-5 illustrate a contact lens 10 designed according to the present invention, which may be a soft, rigid, corneal or scleral contact lens formed from standard contact lens materials. As shown in fig. 1-2, a contact lens 10 is adapted to be worn on a cornea 12 of a patient's eye 14. As shown in fig. 3, the contact lens 10 has at least three correction zones on the convex front surface of the contact lens 10, listed from the center to the periphery of the lens 10: a central optical zone (for hyperopia) 20; ADF area (for adjusting eye defocus) 21; and an intermediate zone 24, the intermediate zone 24 may be a lens zone. The concave back surface of such an anti-defocus (ADF) contact lens 10 may be spherical, aspherical, dual geometry or inverse geometry lens design.

Optical zone 20 has a back side defined by base curve 30b and a front side defined by center curve 30a and ADF curve 31 a. The front optical zone 20 in the present invention is divided into at least two concentric zones. The optical zone 20 is a central zone having a central curve 30a on the front face and is designed to have optical power for correcting distance vision. Located outside optical zone 20 is ADF region 21 with ADF curve 31a on the front surface, which is designed with optical power to correct defocus of the near or far vision peripheral eye. The difference between the central optical region 20 and the ADF region 21 is the defocus resistance (ADP) for correcting the defocus of the eye.

Although two adjacent annular regions may be created for the central optical region 20 and ADF region 21, respectively, different small regions with significant power differences may cause image jumps, clutter, or double vision. In a preferred embodiment, the two regions 20a and 21a thus merge with a continuous aspherical curvature having a positive or negative eccentricity value for a smoother transition.

Together, the optical zone 20 and the ADF zone 21 preferably have a diameter of about 3mm to 8mm, more preferably 6mm, i.e., 3mm on each side of the geometric center of the lens. The lens preferably has an aspherical anterior optical curve 30a and an ADF curve 31a that progressively steepen or flatten radially outward from the geometric center of the contact lens 10. In an H-ADF lens, the maximum defocus resistance (ADP) of the outermost (most peripheral) edge of ADF region 21 is preferably +3 diopters to +30 diopters; or from-3 diopters to-30 diopters in an M-ADF lens for different image housing mismatch conditions. For successive anterior center-ADF regions 20a-21a with aspheric anterior center-ADF curves 30a-31a, anterior center optical region 20a and anterior ADF region 21a may merge smoothly to ensure that a clear, far-center image is formed at the foveal region of eye 14 and that image mismatch is corrected at the parafoveal, near-foveal and peripheral portions of the retina. The formula for calculating the e value of the combined two regions is e=sign (R _A -R _B )*SQRT((R _A ² -R _B ² ) (area A +)Region B), wherein R _A Is the radius of curvature of the central optical zone, and R _B Is the radius of curvature of the ADF region 21 a. The (region a+region B) is the half-region width of each of the two regions, i.e., the central optical region 20 and the ADF region 21.

Using a contact lens material with a refractive index of about 1.4 to 1.6, the e-value of the two regions 20a and 21a combining anti-defocus with adp+3 to +30d is typically-0.7 e to-3.0 e for the front face, and the e-value of ADP-3 to-30D is typically +0.7 to +3.0e for the front face. The contact lens 10 must be precisely centered on the fovea to perceive light from the central optical zone 20a to achieve a small spherical aberration.

For a hyperopic defocus-preventing contact lens 10, the front face of the lens may have a central optical zone 20 of 0.5mm to 1.0mm in diameter and a larger positive ADF zone 21 (in this case an H-ADF zone) of 3mm to 4mm annular shape relative to each side of the central optical zone 20, with an overall diameter of 6mm to 10mm (i.e., the diameters of the optical zone 20 and ADF zone 21 together). The ADP power difference between the central optical region 20 and the outermost portion of the H-ADF region 21 is between +1.00D and +30D. The H-ADF region 21 (adjacent to and beginning with the same power of the central optical region 20 on the horizontal meridian 51) is made to have progressively more positive power or less negative power along the horizontal meridian 51, with a negative e-value (p-value > 1). The focal length of the H-ADF region 21 gradually shortens along the horizontal meridian to the shortest focal length (minimum negative power or maximum positive power) of its outermost edge (periphery 21 c), while the vertical meridian 52 is formed with a zero e value (p value=1) for single vision curvature. The central optical region 20 and ADF region 21 may also be combined with a certain value of e to become a continuous central-ADF region 20-21 as described above. The horizontal and vertical meridians 50 of the central ADF regions 20-21 merge with progressively changing e-values of the continuously smooth aspheric surface. The intensity of the defocus-resistant power ADP can be controlled with a gradient e value between ±0.1e and ±3.0e. The actual ADP effect of the contact lens 10 measured on the eye 14 is a minimum of-0.50 diopters (N10 and T10) at 10 degrees of myopia on each side of the fovea and progressively increases to a minimum of-2.00 diopters (N20 and T20) at 20 degrees on each side of the fovea.

For a myopic defocus-resistant (M-ADF) contact lens 10, the front face of the M-ADF lens 10 may have a central optical zone 20 of 0.5mm to 1.0mm in diameter and annular rings of 3mm to 4mm on each side of the central optical zone 20, the more positive ADF zone 21 (in this case the M-ADF zone), having an overall diameter of 6mm to 10mm (i.e., the diameters of the optical zone 20 and the ADF zone 21 together). The ADP power difference between the central optical region 20 and the outermost portion of the M-ADF region 21 is between-1.00D and-30D. The M-ADF region 21 adjacent to and beginning with the same power of the central optical region 20 on the horizontal meridian 51 has a progressive positive or negative power along the horizontal meridian 51 at a positive e value (p value < 1). The focus of the M-ADF region 21 progressively lengthens along the horizontal meridian to the longest focal length (minimum positive power or maximum negative power) in its outermost edge (periphery 21 c), while the vertical meridian 52 is formed with a zero e value (p value=1) for single vision curvature. The central optical region 20 and ADF region 21 may also be combined with some of the previously described values of e to form a continuous central-ADF region 20-21. The horizontal and vertical meridians 50 of the central ADF regions 20-21 merge with progressively changing e-values to form a continuously smooth aspheric surface. The intensity of the defocus-resistant power ADP can be controlled with a gradient e value between ±0.1e and ±3.0e. The actual ADP effect of the contact lens 10 measured on the eye 14 is at a minimum of +0.50 diopters (N10 and T10) at 10 degrees distance from each side of the fovea and progressively increases to a minimum of +2.00 diopters (N20 and T20) at 20 degrees distance from each side of the fovea.

Referring to fig. 3-5, the near vision contact lens 10 tends to thicken toward the peripheral edge with a higher power. To reduce the peripheral edge thickness of the ADF contact lens 10 of the present invention, a steeper lens curve than the curves 30a or 31a of regions 20 and 21 may be introduced radially outward from ADF region 21. In contrast to near vision lenses, the front, low-level near vision or far vision contact lens 10 may become too thin at its edge and thus crack or fracture more easily than desired, so to increase the peripheral edge thickness of the ADF contact lens 10, a lens-like curve that is flatter than curve 30a or 31a may be incorporated radially outward from ADF region 21 a.

For optical or therapeutic reasons, one or more optional intermediate regions within the radially outward region 24 having a half-zone width of 2.0mm to 5.0mm may also be added between the anterior ADF region 21a and the lenticular curve. For example, the intermediate zone 24 may be added with the same corrective power for the central optical zone 20, which may further enhance peripheral far-incident light for better night distance vision.

After a close examination of the patient's eye and associated ocular tissue, the different radii used to define the base curve in contact lens 10, i.e., the base curve and its relative thickness of optical zone 20, ADF zone 21, connecting zone 26, and peripheral zone 28, are calculated. The corneal curvature must be measured, the appropriate contact lens power determined, and the desired physiological response to the contact lens 10 must be determined. Those skilled in the art of examination of eye systems are able to perform these tasks.

Defocus-resistant orthokeratology

It is another object of the present invention to provide an orthokeratology contact lens 10 that provides effective correction of peripheral eye defocus. It is another object of the present invention to provide an orthokeratology contact lens 10 that corrects refractive errors including, but not limited to, hyperopia, myopia, presbyopia, and astigmatism, which are desirable for correcting vision efficiency problems.

These objects of the invention are achieved by providing an apparatus and method for correcting refractive errors using peripheral eye defocus states in a patient's eye. According to the method of the present invention, an anti-defocus (ADF) orthokeratology contact lens 10 (e.g., as shown in fig. 6-9) is mounted onto the cornea of a patient's eye, the contact lens 10 having a back surface with a plurality of zones, the back surface comprising a central optical zone having front and back surfaces (20 a, 20 b), the front and back surfaces (20 a, 20 b) having respective curves (30 a, 30 b), respectively; ADF zone 21 having ADF base curve 31b, intermediate zone 24 (plateau zone in a distance vision lens), attachment or mounting zone 26, and alignment and/or peripheral zone 28. ADF base curve 21b is carefully created to flatten or steepen the mid-peripheral corneal curvature so that cornea 12 has an anti-defocus mid-peripheral portion surrounding the central region created by base curve 20b of far vision optical zone 20. The target power of the optical zone 20 for correcting distance vision may be determined by the eye care practitioner for fitting the corrective lens. The shape of the ADF regions (21 a, 21 b) may be obtained by testing the defocus of the eye with an ADF test spectacle lens or an ADF test contact lens as described above.

In accordance with the apparatus of the present invention, a contact lens 10 is provided having an optical zone curve (30 a, 30 b) portion of the lens, an ADF curve (31 a, 31 b) portion of the lens circumscribing and coupled to the optical zone curve portion, a plateau curve in the intermediate zone 24 and/or a fitting curve in the connection zone 26 of the lens circumscribing and coupled to the ADF curve (31 a, 31 b) portion, and an alignment curve and/or a peripheral curve in the peripheral zone 28 portion of the lens circumscribing and coupled to the intermediate zone 24 or connection zone 26 portion.

The diameter of the central optical zone 20 of the contact lens 10 may preferably vary between 1.0mm and 3.0mm for the different purposes of correcting myopia, hyperopia or presbyopia. The area width of ADF area 21 may preferably vary from 1.0mm to 4.0mm for reshaping a predetermined myopic or hyperopic peripheral eye defocus on the corneal surface. The total diameter of optical zone 20 and ADF zone 21 together is preferably 4.0mm to 8.0mm, which may be incorporated for H-ADF orthokeratology contact lens 10 to remove presbyopic defocus for aspherical optical-ADF curves having decentration values of-0.1 e to-3.0 e, or +0.1e to +3.0e for M-ADF orthokeratology lens 10 to remove myopic defocus on cornea 12 of eye 14.

Anti-defocus (ADF) orthokeratology contact lens 10 may be spherical, non-spherical, dual geometry, and/or reverse geometry designs as taught in U.S. patent nos. 6,652,095, 7,070,275, and 6,543,897 for orthokeratology RGP (rigid gas permeable) lenses.

For treating myopes with peripheral hyperopic defocus, the base curve 30b should preferably be flatter than the central corneal curvature. The central optical zone 20 and ADF zone 21 should be wider and preferably 3mm to 4mm for better distance vision. For treating hyperopia, base curve 30b should preferably be steeper than the central corneal curvature. For treating presbyopic subjects, the central optical zone 20 may be divided into two portions. The inner optical zone should be designed to be very small for near vision to prevent it from interfering with distance vision, while the outer optical zone should be slightly wider to model the juxtaposed central corneal zone into a flatter zone to account for distance vision (reducing myopia, hyperopia, or astigmatism, if any).

After a close examination of the patient's eye 14 and associated eye tissue, the curves defining the base curves (30 a, 30 b) and ADF curves (31 a, 31 b) in the contact lens 10, as well as the curves of the intermediate zone 24, the connecting zone 26 and the peripheral zone 28, and their relative thicknesses, are calculated. The corneal curvature must be measured, the appropriate contact lens power determined, and the desired physiological response to the contact lens 10 must be determined. Those skilled in the art of examination of eye systems are able to perform these tasks.

Defocus-resistant refractive surgery

It is another object of the present invention to provide a method of designing parameters for refractive surgery (LASIK/LASEK) performed on a cornea 12. The addition of anti-defocus parameters is also used to correct peripheral eye defocus to improve vision efficiency problems while correcting hyperopia, myopia, presbyopia and astigmatism by surgery. Similar to performing orthokeratology, the shape of ADF region 21 may be obtained by testing the defocus of the eye with an ADF test spectacle lens or an ADF test contact lens as described above prior to performing the procedure. The cornea shape thus designed forms a treatment zone with a central zone, preferably varying from 1.0mm to 3.0mm, for the different purposes of correcting myopia, hyperopia or presbyopia. The area width of ADF region 21 adjacent to central region 20 and radially outward from central region 20 may vary from 1.0mm to 4.0mm for correcting a predetermined myopic or hyperopic peripheral eye defocus on the corneal surface. The total diameter of the central optical zone 20 and the ADF zone 21 is preferably 5.0mm to 8.0mm, which may be combined for correcting presbyopic defocus for an aspherical central-ADF zone 20-21 with an decentration value of-0.1 e to-3.0 e, or an decentration value of +0.1e to +3.0e for correcting myopic defocus on the cornea 12 of the eye 14.

LASIK/LASEK surgery may be a supplemental procedure for eyes with center and peripheral image mismatch after cataract surgery for insertion of different types of IOLs into both eyes. The intensity of the eye defocus can be determined using the ADF test set described above and corrected for LASIK/LASEK surgery.

Description of the embodiments

Example 1

Case 1 is an 11 year old female with external strabismus (XT), in which one eye moves outward from age 2. She underwent strabismus surgery at age 7, but unfortunately developed an occult strabismus (ET), with inward shift of the right eye, manifested as a double vision, and myopia developed soon after surgery. The appearance of the double vision after ET formation is caused by disruption of sensory accommodation for the presence of the XT with suppressed dark spots. We used 55% metafilcon (metafilcon) soft H-ADF contact lenses and surprisingly found that the eye position straightened out at both near and far distances without fixation. Myopia has also ceased to progress for 4 years since the wearing of anti-defocus contact lenses.

< Right eye ADF Soft contact lens >

Center focal power: -1.25D (myopia)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (central front curve): 9.54mm

Front ADP: +10D

Front level e-1.11 (p=2.23)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

< left eye >

Center focal power: -0.75D (myopia)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (central front curve): 9.43mm

Front ADP: +10D

Front level e-1.08 (p=2.17)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

Following the peripheral eye defocus theory, ET is surgically induced, while the basic problem remains XT. The XT used for sensory adaptation inhibits the destruction of dark spots by surgery, becomes ET, with obvious double vision and progressive myopia. It is assumed that congenital presbyopic defocus induces XT, while surgery adjusts the extraocular muscles to rotate the eye inward without correcting presbyopic defocus. The peripheral image shell does not meet the fusion zone of the panum, which is required to correct the eye and rotate the eye inward after surgery, which in turn destroys the suppressed dark spots created for the adaptation of the XT sensation with the appearance of presbyopia and myopia progression. Whereas H-ADF contact lenses correct for defocus in the eye for congenital hyperopia for better binocular fusion and correction of the eye, regardless of whether the eye position is XT or ET. This case strongly suggests that strabismus in this case is secondary to peripheral eye defocus and myopia is secondary to a severe effort of postoperative fusion with induced double vision, which explains how H-ADF contact lenses improve eye refractive and simultaneously stop myopia progression.

Example 2

Case 2 is a 9 year old boy diagnosed with ADD (attention deficit disorder) and taking concorta daily, although there is little assistance in reading and understanding. He had a history of meconium inhalation and resuscitation, but this was too flat to do before he reached school age and was found to be unable to learn. The optometrist found that he had serious eye tracking problems and was triaged for visual efficiency assessment. SCCO testing showed that "fixation maintenance" was fairly normal, but failed completely in burst & Saccade. Right eye refractive was normal and left eye +0.50D mild hyperopia. OEP 21 point examination showed under fusion (CI). When the SCCO test is performed, he cannot follow the target, and both eyeballs are continuously shifted upward while checking the catch-up and overflow phenomena, and both hands are stretched under tension. Since severe eye movement dysfunction and CI are very unusual for VT, we decided to try H-ADF soft contact lenses and follow-up 1-2 months before Vision Training (VT).

< Right eye H-ADF Soft contact lens >

Center focal power: plano (zero power)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (central front curve): 8.92mm

Front ADP: +10D

Front level e-1.06 (p=2.12)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

< left eye H-ADF Soft contact lens >

Center focal power: +0.50 (myopia)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (central front curve): 9.17mm

Front ADP: +10D

E-value before horizontal-1.05 (p=2.10)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

After 2 months of wear of the H-ADF contact lens, we again examined SCCO burst & Saccade. His face appeared calm and relaxed throughout the test. There was no more limb overflow during the trial (overflow phenomenon). He can follow the moving object well, with no more eyeballs moving upwards than occasional missing positions. This suggests that peripheral eye defocus can cause binocular misalignment, often misdiagnosed as neurological or psychological problems, and treat improper eye movement dysfunction. With a significant improvement in eye movement function, we arrange VT to further fine tune visual skills.

Example 3

Case 3 is a 25 year old male with reading problems and excessive myopia. He was in front of his class until grade 11, age 17, at which time he became hard to read due to severe headache, with literal fluctuations after 10 minutes of reading. Myopia also develops rapidly with the difficulty of school study. He tried to stop myopia progression using atropine, RGP and reading glasses, but was ineffective. He also tried VT but with little help. The disorder causes anxiety and insomnia, and is diagnosed with depression requiring antidepressants.

< initial OEP 21 Point inspection >

Refractive (# 7): right eye-15.25-3.00 x 170 ° (myopia-15.25D with astigmatism 3.0D)

Left eye-15.00-0.75@0° (myopia-15.00D with astigmatism 0.75D)

Remote strabismus (# 8) 10ΔXP (external strabismus)

Near-distance strabismus (# 13) 25 DeltaXP (external strabismus)

Fixation difference (Wesson card): near OD inhibition

Adjusting focal power: OD 4.00D, OS 3.50D

(other visual efficiency data is not available due to severe OD suppression)

Diagnosis is from lack of Convergence (CI) and lack of Accommodation (AI) that have never been diagnosed and treated, which may also be the cause of rapid progression of myopia.

He resides outside the city and cannot perform the conventional VT. We decided to improve the lack of accommodation, convergence, and hopefully slow the progression of myopia in combination with H-ADF soft contact lenses.

< Right eye H-ADF Soft contact lens >

Center focal power: 13.50 (near vision 13.50 diopters)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (pre-center curve): 13.43mm

Front ADP: +25D

Front horizontal e-value-2.18 (p=5.84)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

< left eye contact lens >

Center focal power: 13.50D (near vision 13.50 diopters)

center-ADF regions 20-21: BOZ (zone width) 8.5mm,

BOZR (radius of curvature) 9.0mm

For (pre-center curve): 13.43mm

Front ADP: +25D

Front horizontal e-value-2.18 (p=5.84)

Intermediate regions 24-26: half-zone width 1.16mm, radius of curvature 7.28mm

Peripheral region 28: half-zone width 1.0mm, radius of curvature 9.8mm

This pair of ADF lenses significantly and instantaneously reduces near-external strabismus. Far 10Δxp decreases to 6Δxp and near 25Δxp decreases to 12Δxp. The solid disparity was immediately checked with a pair of ADF lenses, showing that there was no longer OD ICS with 9 delta-dependent XP (oblique-looking) at 40 cm.

Let us go home with H-ADF soft contact lenses for daytime wear without VT. He reported that he could wear contact lenses and learn comfortably throughout the day without additional assistance and without headache. After wearing the H-ADF lens for 11 months we reexamined his visual efficiency, did not find myopia progression and found near normal visual efficiency data.

< check OEP 21 Point inspection (11 months after initial inspection) >)

Refractive (# 7): right eye-15.25-3.00 x 170 ° (myopia-15.25D with astigmatism 3.0D)

Left eye-15.00-0.75@0° (myopia-15.00D with astigmatism 0.75D)

< visual Effect inspection wear H-ADF Soft contact lens

Remote invisible strabismus (# 8) 5ΔXP (external invisible strabismus)

Near-distance strabismus (# 13) 12ΔXP (external strabismus)

Short-range vergence: #16a12Δ; # 16B18/10Δ

#17A12Δ；#17B 24/15Δ

Fixation difference (Wesson card): zero difference

Adjusting focal power: OD 4.25D, OS 4.25D

This case shows that the cause of peripheral hyperopic defocus is insufficient convergence. The ADF device can correct optical anomalies and improve CI. Long-term ADF device use improves range of motion (# 16 and # 17) and binocular fusion, which in turn cures dyslexia and prevents myopia progression.

Although the present invention has been described in considerable detail with reference to certain preferred embodiments, other embodiments are possible. For example, the steps disclosed for the present method are not intended to be limiting, nor are they intended to represent that each step is necessary for the method, but are merely exemplary steps. Therefore, the scope of the appended claims should not be limited to the description of the preferred embodiments contained in this disclosure.

Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each separate value is incorporated into the specification as if it were individually recited herein. All references cited herein are incorporated by reference in their entirety.

Claims (24)

1. A lens for correcting defocus of a peripheral eye, the lens having a front face and a back face, the lens comprising:

a central zone 20 in the central portion of the lens, the central zone having a lens power for correcting refractive errors; and

an aspherical annular anti-defocus (ADF) region 21, adjacent to the central region 20 and extending radially outwardly from the central region 20,

wherein the lens is an ophthalmic lens or a contact lens, and

wherein the front or back surface of the lens has a horizontal meridian and a vertical meridian each having an e-value, wherein the vertical meridian of the ADF region has a lower asphericity than the horizontal meridian of the ADF region, and wherein the curvature of the surface of the lens between the horizontal meridian and the vertical meridian blends with the progressively changing e-value to form a smooth optical surface.

2. The lens of claim 1, wherein the vertical meridian of the ADF region 21 has an e value of zero.

3. The lens of claim 1, wherein the vertical meridian has an e-value less than 1/2 of the e-value of the horizontal meridian.

4. The lens of claim 1, wherein the vertical meridian of the ADF region 21 is a single view curve having the same power as the central region 20.

5. The lens of claim 1, wherein the lens is an ophthalmic lens, wherein the horizontal meridian and the vertical meridian are located on a front face of the lens, wherein the central region has a diameter between 1.5mm and 4.0mm, and wherein the central region and the ADF region together have a diameter between 18mm and 28 mm.

6. The ophthalmic lens of claim 5, wherein the horizontal meridian of the ADF zone is aspheric and has a positive progressive power radially outward from the inner boundary of the ADF zone and has an anti-defocus power (ADP) of +1.00 to +20.0 diopters, the ADP being defined as the power difference between the outer periphery of the ADF zone 21 and the outer periphery of the central zone 20, wherein the lens is useful for treating presbyopic defocus.

7. The spectacle lens of claim 5, wherein the horizontal meridian of the ADF region 21 is aspherical and has a progressive negative power radially outward from the inner boundary of the ADF region and has an anti-defocus power (ADP) of-1.00 to-20.0 diopters, the ADP being defined as the power difference between the outer periphery of the ADF region 21 and the outer periphery of the central region 20, wherein the lens is useful for treating myopic defocus.

8. The lens of claim 1, wherein the lens is a contact lens, wherein the central region has a diameter of between 0.5mm and 1.0mm, wherein the ADF region 21 extends radially outwardly from the central region at least 3mm and 4mm, and wherein the central region 20 and annular ADF region 21 together have a diameter of between 6mm and 10 mm.

9. The contact lens of claim 8, wherein the front or back of the central region 20 and the ADF region 21 each have an e-value, wherein the e-values of the central region and the ADF region combine to form an aspheric central-ADF region 20-21, and wherein the horizontal and vertical meridians of the central-ADF region 20-21 combine with rotationally progressive e-values to form a central-ADF region having a continuously smooth aspheric surface.

10. The contact lens of claim 9, wherein the rotational progressive e value along axis X ° of the center-ADF region _x EDerived by the following formula:

E _x ＝SIGN(XR _p -R _c )*(ABS(XR _p ² -R _c ² )) ^1/2 /d (2.2)

Wherein XR _p Is the radius of curvature at a point radially outward along the axis X DEG by a distance d, and wherein XR _p Derived from the following formula:

XR _p ＝HR _p +sin(X ^o ) ² *(VR _p -HR _p ) (2.1)

And wherein:

R _c Is the radius of curvature at the center of the contact lens;

HR _p is the radius of curvature at a point radially outward along the horizontal meridian by a distance d; and

VR _p is the radius of curvature at a point radially outward along the vertical meridian by a distance "d".

11. The contact lens of claim 9, wherein the vertical meridian has an e value of zero and has single vision power throughout the center-ADF region 20-21, and wherein the e value of the horizontal meridian is non-zero and is between ± 0.1e and ± 3.0 e.

12. The contact lens of claim 11 for use in treating presbyopic defocus, wherein the horizontal meridian has a positive power progressing radially outward from a central portion of the contact lens and has an anti-defocus power (ADP) of +1.00 to +30.0 diopters, ADP being defined as a power difference between an outer periphery of the ADF region 21 and an outer periphery of the central region 20, wherein an e value of a front face of the horizontal meridian is between-0.1 e and-3.0 e, or wherein an e value of a back face of the horizontal meridian is between +0.1e and +3.0 e.

13. The contact lens of claim 11 for use in treating myopic defocus, wherein the horizontal meridian has a progressive negative power radially outward from a central portion of the contact lens and has an anti-defocus power (ADP) of-1.00 to-30.0 diopters, the ADP being defined as the power difference between the outer periphery of the ADF region 21 and the outer periphery of the central region 20, wherein the front of the horizontal meridian has an e value of between +0.1e and +3.0e, or wherein the back of the horizontal meridian has an e value of between-0.1 e and-3.0 e.

14. The contact lens of claim 8 for use in performing orthokeratology, wherein the horizontal meridian and the vertical meridian are located on the back of the lens to achieve corneal shaping, and wherein the ADF region has an e value of between ±0.1e and ±3.0 e.

15. The contact lens of claim 8, further comprising:

an intermediate region 24 coupled to the ADF region 21 and extending radially outward from the ADF region 21, the intermediate region having a region width of 2.0mm to 5.0 mm;

a connection region 26 coupled to and extending radially outwardly from the intermediate region 24 for supporting the contact lens on a cornea; and

a peripheral region 28 connected to the outer periphery of the contact lens.

16. The contact lens of claim 8, wherein the lens is a rigid contact lens, a rigid scleral lens, or a soft contact lens.

17. A method for correcting peripheral eye defocus in an eye of a subject to improve or correct vision efficiency problems, the method comprising the steps of:

(a) Determining an anti-defocus power (ADP) of a lens having a central region 20 in a central portion thereof and an anti-defocus (ADF) region 21 adjacent to the central region 20 and extending radially outward from the central region 20, wherein the central region has a central focus to form a central image at a foveal retina for correcting ametropia, wherein ADP is defined as a difference in power between an outer periphery of the ADF region 21 and an outer periphery of the central region 20, and wherein the determined ADP is sufficient to counteract peripheral eye defocus and realign peripheral images in the subject's eye to improve peripheral fusion and visual efficiency; and

(b) Providing the lens to the subject.

18. The method of claim 17, wherein determining the defocus power (ADP) further comprises the steps of:

(i) Examining baseline visual efficiency data of the subject;

(ii) Selecting an ADF test lens based on the type of visual efficiency problem experienced by the subject;

(iii) Testing the original eye defocus intensity by progressively introducing the ADF test lenses from lower ADP to higher ADP until the best ADP that achieves maximum normalization of visual efficiency data is determined; and

(iv) Providing the subject with a pair of ADF spectacle lenses or contact lenses having optimal ADP.

19. The method of claim 18, further comprising the step of:

repeating steps (i) to (iv) after the subject has worn the provided spectacle lens or contact lens for a predetermined period of time.

20. The method of claim 17, wherein the horizontal meridian of the ADF region 21 is aspheric and has a positive progressive power radially outward from an inner boundary of the ADF region, wherein the ADF region has an ADP of +1.00 to +20.0 diopters, and wherein the lens is used to correct binocular efficiency problems or for myopia control with presbyopic defocus.

21. The method of claim 17, wherein the horizontal meridian of the ADF region is aspheric and has a progressive negative power radially outward from an inner boundary of the ADF region, wherein the ADF region has an ADP of-1.00 to-20.0 diopters, and wherein the lens is for treating myopic defocus.

22. The method of claim 17, further comprising the step of: an ADP effect is induced in the subject's eye, the ADP effect having a minimum of 0.50 diopters in peripheral focus relative to anterior (more myopic) or posterior (more distant), the ADP effect measured at 10 degrees relative to each side (N10 and T10) of the subject's foveal retina.

23. The method of claim 17, further comprising the step of: an ADP effect is induced in the subject's eye, the ADP effect having a minimum of 2.00 diopters relative to anterior (more myopic) or posterior (more distant) in peripheral focal spot, the ADP effect measured at 20 degrees relative to each side (N10 and T10) of the subject's foveal retina.

24. The method of claim 17, wherein the problem of visual efficiency selected from the group consisting of eye movement dysfunction, accommodation dysfunction, vergence dysfunction, and abnormal sensory accommodation is treated.